GI Disorders (CH 29-31)

Dark stool can be due to

(Melena): Upper GI bleeding, long term NSAID use, bismuth, or iron supplements.

Treatment of Upper GI bleeds/disorders

-Lifestyle modifications such as weight loss if obese -Decreased alcohol and coffee intake, and smoking cessation Esophagitis that occurs more often can be treated with PPIs such as lansoprazole (PrevacidR) for four to eight weeks. (Proton Inhibitor Pumps) Some clinicians suggest PPIs or histamine-2 receptor antagonists such as ranitidine (ZantacR) for patients with ulcerlike symptoms. These agents decrease gastric acid production by inhibiting the proton pump mechanism and blocking histamine-2 receptors in gastric parietal cells.

Hepatitis A & E are transmitted by

Feces Food Water Fecal-oral route!

Hernia

A hernia is a protrusion of the small intestine through a muscular wall or fascia. Several types of hernia exist, depending on the location of the protrusion. Acts such as coughing raise the intrabdominal pressure, making it more likely for the protrusion to be observed. A HIATAL hernia is when a portion of the stomach/abdominal organ protrudes into the diaphragm and produces symptoms of GERD.

Cirrhosis and liver failure

1.) A chronic, progressive disease of the liver characterized by diffuse degeneration and destruction of hepatocytes. 2.) Repeated destruction of hepatic cells causes the formation of scar tissue. COMPLICATIONS: * Portal hypertension * Ascites * Bleeding esophageal varicies. * Coagulation defect. * Jaundice * Portal systemic encephalopathy * Hepatorenal syndrome-splenomegaly. Cirrhosis is late stage FIBROTIC scarring of the liver. The scarring manifests as a result of damage to the liver. Liver function becomes impaired, as indicated by laboratory results. The disease is NOT rapid in onset and does not present with acute symptoms in the early stages. Portal hypertension often develops in response to cirrhosis, as the veins become blocked by the damaged liver. Hepatitis C, not hepatitis A, is more likely to cause cirrhosis.

Upper GI bleed

A rupture, tear, or perforation in the esophageal or gastric lining, resulting in blood loss. Classic symptoms of UGIB include hematemesis, melena, and occult blood. May be due to esophageal varices due to cirrhosis of liver. HEMATEMESIS is vomitus with bright-red, bloody streaks or a dark, coffee-ground appearance. The presence of bright-red blood indicates a current bleed. MELENA is occult blood in the stool that causes a black, tarry appearance. Occult blood is the presence of blood in the stool that is not visible. Sx: A sudden or massive UGIB may present with rapid onset of anxiety, dizziness, weakness, shortness of breath, or change in mental status. Tachycardia and tachypnea will occur because of decreased cardiac output. The skin will be pale and clammy as a result of the body's effort to shut down peripheral blood flow.

Upper GI bleed diagnostics/tests

A slow GI bleed may reveal low hemoglobin and low iron levels, which confirm the presence of anemia. A stool guaiac test, also known as a fecal occult blood test (FOBT), can determine the presence of blood in a stool sample. -BUN levels will be elevated secondary to decreased fluid volume and the absorption of blood proteins into the small intestine. Diagnostic tests include endoscopy, CBC, and stool samples for occult blood.

IBS primary symptoms?

Abdominal pain also occurs in irritable bowel syndrome (IBS). Patients experience frequent episodes of abdominal pain, bloating, and abdominal distention. There are also bouts of constipation and diarrhea; however, there is NO pathological change within the interior of the bowel, and etiology is unclear.

Ulcerative colitis

Affects ONLY the large intestine (specifically the upper layers aka the mucosa), whereas Crohn's is transmural and affects the entire wall of the intestine. Pseudopolyps, which look smaller, thinner and more numerous than cobblestoning seen in Crohn's, is shown during colonoscopy. CAN lead to colon cancer. No annal fistulas like in Crohn's.

What two things are the main causes of cirrhosis?

Alcohol and hepatitis C.

Alcoholic liver disease

Alcoholic liver disease develops as a result of excessive alcohol consumption. As the liver processes alcohol, excessive consumption may lead to damage to the liver cells. Liver enzymes, such as AST and ALT may elevate in the serum, indicating damage to hepatocytes. Liver processing of lipids may be impaired resulting in elevated triglycerides and cholesterol. Steatosis, the accumulation of fat in liver cells, may also occur. With severe damage, the liver is no longer able to detoxify the blood. For example, ammonia levels may increase to the point that damage to the nervous system, including the brain, results. This is known as hepatic encephalopathy.

Acute pancreatitis may cause autodigestion of the pancreas and result in elevation in the serum of pancreatic ______________ and ________________

Amylase and lipase. a key sign for pancreatitis is the elevation in the serum of the digestive enzymes from the pancreas, amylase and lipase.

Acute pancreatitis may cause autodigestion of the pancreas and result in elevation in the serum of pancreatic ______________ and _________________.

Amylase, lipase

Large intestinal mobility dysfunction

Any alteration in the transit of foods and secretions in the digestive tube may be considered an intestinal motility disorder. These would include: an obstructive lesion, intestinal pseudo-obstruction (Ogilvie syndrome), IBS, fecal incontinence, and constipation.

Inflammation of large colon disorders

Appendicitis, diverticulitis, and IBD.

Which of the following may cause hyperbilirubinemia?

Bile duct obstruction, hepatocyte injury, increased RBC breakdown

Hepatitis B is caused by

Blood, body fluids, and sexual contact.

The physical examination findings of a patient who has liver disease show dilated veins over the umbilical area of the abdomen. What is this finding called?

Caput medusa.

Excessive laxative use disorder

Cathartic colon Chronic use of stimulatory laxatives can lead to cathartic colon. In this condition, the colon undergoes anatomical and physiological changes in response to the laxative use. The colon may become atonic, making fecal evacuation difficult.

Anna's disorder is detected by a positive antibody test and confirmed through a biopsy of the small intestine and is also known as gluten-sensitive enteropathy. What disorder does Anna have?

Celiac disease.

CT scans later reveal the presence of gallstones in Laura's gallbladder. Most gallstones are comprised of ____________________

Cholesterol! Calcium make up most kidney stones.

Chronic gastritis

Chronic gastritis, also known as nonerosive gastritis, is associated with an underlying disease or severe infection. It is different than acute gastritis because it causes ATROPHY of the glandular stomach lining, a condition called atrophic gastritis. The presence of the H. pylori bacterium, which usually affects the fundus of the stomach, is the most common cause. Symptoms associated with chronic gastritis include burning or gnawing epigastric pain, nausea, weight loss, anorexia, and hematemesis *Precursor to development of stomach cancer*

Crohn's disease

Chronic inflammatory process involving ANY portion of the GI tract from the mouth to the anus. chronic, incurable diseases that can occur at any age. The rate of Crohn's disease in women is 1.1 to 1.8 times higher than that in men. Crohn's= Cobblestone appearance. Sx: Cause severe abdominal pain, DIARRHEA, bloody stools, and weight loss. SKIP LESIONS and cobblestoning on exam...occurs within the large intestine as well due to high number of immunoglobulins, T cells, and macrophages. Possible anal fistula and anal lesions. Malabsorption and nutritional deficiencies are a prominent sign of Crohn's disease with resultant anemia and fatigue.

Two types of IBD?

Crohn's and ulcerative colitis. => causes severe abdominal pain, diarrhea, bloody stools, and weight loss.

Nick complains of abdominal pain and bouts of diarrhea. He thinks that there may be blood in his stool and he has lost 15 pounds since his last visit 6 months ago. Nick is scheduled for a colonoscopy, which reveals a cobblestone appearance in areas of the colon, interspersed with normal-looking portions. A biopsy sample of the colon shows transmural damage. What disorder does Nick have?

Crohn's disease

Bleeding in the peritoneal and retroperitoneal areas may present as ________________ and ______________ signs in patients with acute pancreatitis.

Cullen and Grey Turner signs ...occur when internal hemorrhage is present in the abdominal area. Cullen sign appears around the umbilicus area, whereas Grey Turner sign appears on the flanks. These signs are often considered a hallmark of acute pancreatitis.

What signs are positive for pancreatitis?

Cullen and grey turner signs

What gastric effect does NSAIDs have?

Decreases mucus production and can lead to ulcers.

Biliary Cirhosis

Destruction of the bile ducts occurs in biliary cirrhosis. The primary form of biliary cirrhosis is considered an autoimmune disease. Thus, inflammatory mediators, such as ESR, and antibodies, such as IgM and AMAs, are elevated. Xanthelasma, which are yellow patches of cholesterol that develop near the eyes, may be present.

A nurse is caring for a patient diagnosed with portal hypertension. What development should the nurse be concerned about?

Esophageal varices.

Hyperbilirubinemia

Excessive level of bilirubin (bile pigment) in the blood and causes JAUNDICE, yellowing of the skin and sclera. -Excessive RBC hemolysis -Hepatocellular injury -Bile duct obstruction

Henry complains of constipation and has a low-grade fever, as well as pain in the abdominal lower left quadrant (LLQ). Acute pain results from certain foods, whereas dull aching pain or no pain occurs after other meals. When reviewing his diet, you notice a lack of dietary fiber. What disorder do you suspect?

Diverticular disease A diet high in fiber is very helpful in preventing diverticular disease. Diverticula are small outpouchings that develop in weakened areas of the bowel, commonly in the large intestine. Sometimes, the pouches can become inflamed. This condition is known as diverticulitis. If the diverticula are on the descending colon, pain will appear in the LLQ.

Gastric dumping/dumping syndrome

Dumping syndrome is caused by rapid gastric emptying. This is a common complication following any surgical procedure that removes part or all of the stomach, such as BARIATRIC surgery. Poorly digested material enters the intestine before its breakdown in the stomach (DIARRHEA). The material tends to be hypertonic, causing a shift of fluid out of the intestinal cells into the intestinal lumen. The fluid shift reduces blood volume, creates hypotension, and stimulates the sympathetic nervous system to increase heart rate.

Margaret has pain in her abdomen that is relieved with eating. She also reports experiencing increasing melena. She states her stomach pain can be quite severe and she is worried her condition is worsening. A urea breath test is positive for H. pylori. What disorder does Margaret have?

Duodenal ulcer Duodenal ulcers are erosions that develop in the small intestine. The presence of MELENA indicates damage and bleeding in the intestinal tract. H. pylori, one of the most common causes of GI ulcers, produces an enzyme that breaks down urea. A positive urea breath test result indicates the presence of H. pylori. H. pylori can damage the GI tract to the point that bleeding occurs.

Jim recently had a stroke. He has a poor gag reflex, deviated tongue, and difficulty swallowing foods. He wants to "give up" eating any type of large meal, because he feels it is too much work to eat. What finding is consistent with Jim's signs and symptoms?

Dysphagia Dysphagia is difficulty swallowing. Most commonly, dysphagia is due to neuromuscular damage preventing the swallowing reflex from working normally. In Jim's case, his stroke likely compromised the neuromuscular component of the swallowing reflex. Eating smaller meals with easily swallowed foods will help Jim.

When you speak with Laura to review her symptoms further, you ask what type of food she eats that tends to result in pain. You know that ________________ foods tend to worsen gallbladder pain.

Eating foods high in fat can increase the sensation of pain in patients with gallbladder issues. Bile is stored in the gallbladder and is released into the small intestine to aid in fat digestion. When high-fat foods are consumed, the gallbladder is signaled to contract and release bile. In individuals with an inflamed gallbladder, pain may occur.

The most accurate method of diagnosing upper GI tract disorders?

Endoscopy. Ex: barium x-rays where patient drinks radiopaque substance.

Ibuprofen (NSAID) can cause

GI irritation or ulceration when used in high dosage

High fat foods worsen the sx of ___

Gallstones/gallbladder pain. Eating foods high in fat can increase the sensation of pain in patients with gallbladder issues. Bile is stored in the gallbladder and is released into the small intestine to aid in fat digestion. When high-fat foods are consumed, the gallbladder is signaled to contract and release bile. In individuals with an inflamed gallbladder, pain may occur.

Tomas complains that he has stomach pain that most commonly occurs when his stomach is empty. He says that eating helps to relieve this pain. He has recently lost weight. His breath test is positive for urea, and endoscopy reveals multiple small erosions in the mucosa of the stomach. What disorder does Tomas have?

Gastric ulcer (PUD) Gastric ulcers are sores that develop in the interior of the stomach. Normally, pain from these sores is worse when the stomach is empty, so eating helps alleviate the pain. One of the most common causes of gastric ulcers is the bacteria, Helicobacter pylori. H. pyloriproduces an enzyme that breaks down urea. Ingestion of tablets of urea can be used to determine the presence of H. pylori based on this enzymatic breakdown of urea.

Zollinger-Ellison syndrome

Gastrin-secreting tumor associated with ulcers ZES is a rare disorder that accounts for fewer than 1% of duodenal or gastric ulcers. It is most commonly caused by a gastrin-secreting tumor (gastrinoma) of the pancreas. The tumor may alternatively be located in the duodenum, lymph nodes, or another site. In ZES, there is constant secretion of gastrin from a tumor. Gastrin stimulates the proliferation of parietal cells, which yield excessive HCl.

Gastroenteritis

Gastroenteritis occurs from an irritation to the lining of the stomach, small intestine, or large intestine by a pathogen or toxin. The disease can occur from a virus, bacteria, parasite, or chemical toxin. Gastroenteritis is transmitted from person to person or can be a waterborne or foodborne illness. (TRAVELING, close proximity to people, etc.)

Which hepatitis virus is the most mild?

HAV (hepatitis A virus). Spread by the fecal-oral route. Leads to no complications. There is a vaccine for hep A and hep B.

Which hepatitis viruses lead to cirrhosis?

HCV and Hep B. No vaccine exists for Hep C., just treatment. Why? it mutates VERY RAPIDLY.

Claire presents in the physician's office with the primary complaint of hematochezia. The appearance of bright red blood was very worrisome for Claire. She also reports pain and itching in the anal area. Claire's rectal exam reveals dilated, swollen veins in the rectum.What disorder does Claire have?

Hemorrhoids Hemorrhoids are dilated veins in the rectum or anus. These veins may enlarge and dilate due to excess STRAINING or from increased pressure such as with pregnancy. Hemorrhoids may be located internally or superficially. Bleeding and itching in the affected area may occur. Hematochezia, or bright red blood from the rectal area, is associated with hemorrhoids.

Hepatitis A

Hepatitis A is a viral form of hepatitis transmitted through the fecal-oral route. It can lead to typical signs of liver problems, including enlargement of the liver and tenderness in the right upper quadrant area. Infection with hepatitis A results in the formation of anti-HAV antibodies, which can be detected with a blood test.

Which of the following are common signs of liver disorders? Select all that apply.

Hepatomegaly, jaundice, increased liver enzymes in the blood.

What causes jaundice?

Hyperbilirubinemia

IBS versus IBD?

IBD causes pathological changes in the lining of the mucosa, IBS does not.

Stephanie complains of abdominal pain off and on for the past 6 months. She thought it would go away but instead has noticed lasting bouts of diarrhea interspersed with periods of constipation. Stephanie has tried different over-the-counter medications to address the symptoms, but nothing seems to be helping. Her most recent colonoscopy reveals no pathologic changes.

IBS

Hepatitis C is caused by

IV drug usage/blood. May progress to chronic hepatitis.

Barrett's esophagus

In early stages of GERD, the gastric acid can quickly erode the protective mucosal epithelial layer and lead to ulceration of the esophagus. Repeated injury to the epithelial layer commonly causes metaplasia, the change of esophageal epithelial cells into stomachlike columnar epithelium. The metaplastic cellular change at the gastroesophageal junction, called Barrett's esophagus, is a precancerous change of cells

Pyloric stenosis

In pyloric stenosis, the pyloric valve, leading from the stomach to the small intestine, does not open properly. As stomach contents cannot leave the stomach as expected, projectile vomiting may be induced. Surgical correction of the stenosis is necessary. -> PROJECTILE VOMITING common and in BABIES, it is a congenital abnormality.

Elevated ALT and AST

Indicate hepatic INJURY.

Acute gastritis

Inflammation in the lining of the stomach. It can be caused by a number of medications and factors such as infection, allergy, acute stress, bile reflux, alcohol abuse, radiation, and direct trauma. Chronic use of aspirin, NSAIDs, or corticosteroids commonly causes gastritis. These medications suppress the inflammatory response and irritate the stomach lining by blocking gastric mucus production. They are known to frequently cause GI bleeding or PUD.

Esophagitis

Inflammation of the esophagus caused by acid reflux Most common complaint is a burning sensation in the throat or midsternal chest. Dysphagia, odynophagia, and heartburn are other symptoms associated with esophagitis. A complaint of a sore throat or tongue and white patches on the tongue, palate, or buccal mucosa are hallmark signs of THRUSH. This condition most commonly arises from an irritation to the mucosa of the esophageal lining by refluxed ACID. It can also be caused by the fungal organism *C. albicans* in immunosuppressed individuals. Associations: infection, chemical ingestion, medications, excessive vomiting, or occasional episodes of acid reflux. Obesity, pregnancy, smoking, alcohol, fatty foods, and coffee increase susceptibility to esophagitis. Some medications, such as calcium antagonists, anticholinergics, NSAIDs, and bisphosphonates, increase susceptibility to esophagitis.

Symptoms of liver disease

Jaundice, nausea, vomiting, weight loss, dark urine, and abdominal distention because of liver dysfunction.

Acetaminophen and aspirin can cause?

LIVER DAMAGE and toxicity

Celiac disease

Malabsorption syndrome caused by an immune reaction to gluten. Detected via positive ANTIBODY tests and confirmed via biopsy of small intestine

Esophageal cancer

Malignant tumor of the esophagus Tobacco use, GERD, and Barrett's esophagus, a complication of GERD, are the primary risk factors for adenocarcinoma of the esophagus.

Wendell complains that his stool has recently been much darker than normal. He states this occurs regardless of what he has eaten. He reports that the darkened stools are happening with increasing frequency. What condition explains Wendell's symptoms?

Melena. Melena occurs when there is a darkening of the stools due to the presence of digested blood.

You want to evaluate Laura's reported pain further. Upon palpation of the right abdomen, Laura cringes as you press down while asking her to breathe in deeply. You consider this to be positive for _______________.

Murphy's sign Murphy's sign is considered positive if pain is elicited on the right side, but not the left side. A positive test may indicate cholecystitis. Cullen and Grey Turner signs may be present in pancreatitis, whereas Chvostek's sign appears with abnormal calcium levels.

What signs are positive for cholecystitis?

Murphy's sign: pain in the right abdominal region.

nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatosis (NASH) are also common pathophysiological conditions of the liver. Although the etiology is unclear, the patient usually has comorbidities of obesity, hypertriglyceridemia, or diabetes. The liver becomes infiltrated with fat and fibrotic tissue. NAFLD is a major cause of cirrhosis.

GERD

One of the major disorders of the upper GI tract. This disorder is diagnosed if a person has esophagitis more than a few times a week. Frequent heartburn can cause GERD, which is a precursor of Barrett's esophagus, a precancerous change of the esophagus. Upper GI tract bleeding can also be due to a bleeding or perforated peptic ulcer. Assessment: Are there nocturnal symptoms, as in GERD? -Older people >40 -Infants

Chronic use of NSAIDS often causes?

PUD and GI bleeding. Also cirrhosis.

Given Laura's history of alcohol abuse and the current condition of cholelithiasis, you are worried about the ________________ being affected.

Pancreas, since the ducts are close together. Chronic pancreatitis usually occurs with chronic alcoholism.

Lisa presents in the emergency department with severe abdominal pain, abdominal rigidity, and significant rebound tenderness. Bowel sounds are hypoactive, and Lisa appears in distress and says even a cough or movement will cause abdominal pain.What disorder does Lisa likely have?

Peritonitis. Peritonitis is an inflammation of the peritoneum, usually the result of bacterial infection. This can evolve into a very serious condition, as the infection can travel to the blood. The hallmarks of peritonitis are pain, rigidity, and rebound tenderness of the abdomen. Pain is usually severe, especially with any type of movement (cough, etc).

What is a common response during cirrhosis?

Portal hypertension often develops in response to cirrhosis, as the veins become blocked by the damaged liver. This is not seen in alcoholic liver disease, which would show elevated liver enzymes, elevated cholesterol and triglycerides.

Assessment for GI disorders

Question patient about swallowing, indigestion, eructation (belching), and abdominal pain. Is the pain a burning, gnawing feeling, as occurs in esophagitis? Does the pain occur with or between meals? Is the pain relieved by food, as in peptic ulcer? Does any emesis contain blood, mucus, or bile? Does it have a coffee-ground appearance, as occurs in upper GI bleeding? Is blood visible in the vomitus? Does the patient take NSAIDs or aspirin? How much coffee does the patient drink? What other medications are taken? Does the patient take antacids, proton pump inhibitors (PPIs) such as lansoprazole (PrevacidR), or histamine-2 receptor blockers such as ranitidine (ZantacR) and how often? The patient's medication list can often be responsible for GI symptoms or reveal information about symptoms. Questioning the patient about ALCOHOL use and SMOKING is also important. One of the major risk factors for upper GI problems is the use of NSAIDs, including aspirin. These medications are often associated with gastric irritation and erosion and can be the cause of PUD. Alcohol use and smoking are associated with esophagitis, peptic ulcer, and esophageal cancer. Alcohol abuse, the etiology of cirrhosis of the liver, can also cause problems for the upper digestive tract. Upper GI bleeding is often caused by esophageal varices, which occur in cirrhosis

________ criteria are used to evaluate severity of acute pancreatitis by examining five characteristics at admission and six additional characteristics within 48 hours.

Ranson criteria.

Where can pain radiate with gallstones?

Right shoulder pain

Peptic Ulcer Disease (PUD)

Sore on the mucous membrane of the stomach, duodenum, or any other part of the gastrointestinal system exposed to gastric juices; commonly caused by infection with Helicobacter pylori bacteria. A gastrin level is done to rule out Zollinger-Ellison syndrome (ZES). RELIEF OCCURS BY EATING FOOD. Duodenal ulceration is four times more common than gastric ulceration. Duodenal ulcers commonly occur in the region termed the duodenal bulb, the upper portion of the duodenum near the pyloric sphincter, because of its proximity to the highly acidic gastric contents of the stomach.Zol Ways to test: -Antibodies to H. pylori can be measured in the BLOOD. -Using an endoscope, a gastric mucosal biopsy can be sampled and tested for H. pylori. -Fecal antigen testing identifies active H. pylori infection in the stool. -Urea breath tests detect active H. pylori infection by analyzing the breath. Associated with enteritis and GERD.

Before cirrhosis, the liver undergoes

Steatosis, the accumulation of fat.

Blood that has a coffee-ground appearance indicates? What about bright red?

The blood has mixed with the stomach's acid. Bright red indicates an active bleed.

Common causes of GERD

The most common cause of GERD is a functional or mechanical problem that decreases muscular tone of the lower esophageal sphincter (LES). Relaxation of the LES allows for regurgitation of stomach contents into the esophagus. Different conditions, foods, and medications can cause decreased strength of the LES. The stomach acid ERODES THE ESOPHAGUS. Also: obesity and pregnancy which places pressure on the LES.

Treatments of GERD

The most effective diagnostic tools for GERD are ENDOSCOPY and manometry. Through an endoscope, the clinician can visualize the esophageal mucosa. Manometry can determine the pressure at the LES. Ambulatory 24-hour pH testing can be done to confirm acid reflux in patients with atypical presentations or when endoscopy fails to reveal reflux. Barium studies

Symptoms of GERD (the disorder)

The most frequent symptoms associated with GERD are dysphagia, heartburn, epigastric pain, and regurgitation. Frequent heartburn may also be described as acid indigestion, or dyspepsia. Individuals often describe regurgitation as a bitter taste in their mouth. Respiratory complaints, such as chronic dry cough, asthma, and aspiration pneumonia, are also associated with the presence of GERD

Jonah presents in the emergency department with a rapid pulse and lightheadedness. Further questioning reveals Jonah has recently experienced hematemesis and melena. What disorder does Jonah have?

UGIB- upper GI bleed. Like any type of significant blood loss, if the UGIB is severe enough, the heart does not receive enough blood to pump because the blood is lost through to bleeding. This results in a rapid heart rate to compensate for falling blood pressure due to blood loss. Melena occurs when blood is present in the stool, while hematemesis is the vomiting of blood.

A clinician is working with Naomi, who appears to have an inflammatory bowel disease. Naomi has symptoms that could indicate ulcerative colitis or Crohn's disease. Her colonoscopy results show inflammation beginning in rectal areas of mucosa only, no cobblestone appearance, and presence of several pseudopolyps. What disorder does Naomi have?

Ulcerative colitis. Pseudopolyps are the greatest indicator of UC.

John presents in the emergency department with a swollen abdomen. He is bent over in intense pain. When asked to describe the pain, John states that it is cramping in nature and going in waves. His abdomen feels tender to touch. John starts vomiting. A lower GI series is ordered, with results indicating surgery is needed. What condition is consistent with John's symptoms?

Volvulus Volvulus is twisting of the intestines. Pain results as ischemia develops in the twisted portion of the intestine. Cramping occurs as gas and fluid collect in the obstructed area. Because contents cannot travel through the intestine, vomiting results. The twisted portion can be visualized with a lower GI series, and surgical correction is needed.

Wilson's disease

Wilson's disease is a rare genetic disorder that causes copper to accumulate in some tissues. Copper may begin to be excreted in the urine at a high level. Golden, brown discoloring of the eyes (Kayser-Fleischer rings) may be apparent and result from copper deposition. Ceruloplasmin levels are low, as copper incorporation onto this transport protein is abnormal. Neurological manifestations may develop in Wilson's disease. One such example is masklike facies, in which the facial expression is flat, almost masklike.

Warren presents with severe duodenal ulcers. As the physician examines the laboratory results, serum gastrin levels are noted to be 20 times higher than normal. What condition is consistent with these findings?

Zollinger-Ellison Syndrome. Tumor produces massive amounts of gastrin, and thus excess acid. Tumor must be removed.

Bilirubin

an orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile. Increases during liver damage/failure.

Inflammation of the gallbladder is known as ________________ and most commonly is caused by gallstones, known as ____________________

cholecystitis, cholelithiasis

Cholelithiasis is?

gallstones Cholecystitis refers to inflammation if the gallbladder, whereas cholelithiasis is the presence of gallstones. Gallstones are the most common cause of inflammation in the gallbladder. Being FEMALE, older than 40, and obese increases the risk of gallstone formation.

Appendicitis

inflammation of the appendix, usually due to obstruction or infection. Signs will be pain over the RLQ, aka McBurney's POINT that started with vague umbilical pain and transgressed to RLQ. Nausea, vomiting, fever, chills, and constipation or diarrhea may be present. Rebound tenderness (pain after palpation), psoas sign, obturator sign,

Hepatitis B

inflammation of the liver caused by the hepatitis B virus (HBV), which is transmitted sexually or by exposure to contaminated blood or body fluids (Blood, Banging, Body fluids!!) Diagnosis of hepatitis B results from positive serology results for the antigen, including HBcAg, as well hepatitis B antibodies, HBc Ig. Hepatitis B presents with a range of symptoms. It is transmitted by blood and body fluids, not the fecal-oral route. A vaccine against hepatitis B is available.

Hepatitis C

inflammation of the liver caused by the hepatitis C virus (HCV), which is transmitted by exposure to infected blood; this strain is rarely contracted sexually. HCV is a virus that targets hepatocytes and B lymphocytes. Acute HCV infection is usually mild, and chronic hepatitis occurs in at least 75% of patients. The mode of transmission is via blood, as in IV drug use. HCV can live dormant in the patient for years before symptoms develop. Hepatitis C is sometimes referred to as a "silent infection," as few signs and symptoms may be present initially. Diagnosis is based on positive RNA assay results for the virus, as well as positive antibody results. Can lead to cirrhosis. THERE IS NO VACCINE.

Liver damage symptoms

jaundice, dark urine, HYPERbilirubinemia, light colored stools, malaise, abnormal discomfort, loss of appetite, ASCITES (due to decreased albumin as the liver produces it when it's healthy), hepatic encephalopathy (increased ammonia levels), increased PT time by decreased coagulation factors.

Cathartic colon

the anatomical and physiological change in the colon that occurs with chronic use of stimulant laxatives. Bloating, feeling of fullness, abdominal pain, and not being able to defecate are symptoms. can cause long term damage.

Foods and substances that irritate lower esophageal sphincter (GERD)

• Alcohol • Chocolate • Coffee • Fatty meals • Medications, including anticholinergics, beta-agonists, calcium channel blockers, nitrates, and hormones such as progesterone • Nicotine • Obesity • Pregnancy

Causes of Cirrhosis

• Alcoholic liver disease • Nonalcoholic fatty liver disease (NAFLD) • Chronic HBV • Chronic HCV