Gould's Pathophysiology Chapter 17- Digestive System Disorders

Posthepatic jaundice

"After the liver" Caused by *obstruction of bile flow* into the gallbladder or duodenum and the subsequent backup of bile into the blood -> tumor, cholelithiasis (gallstones). Bilirubin measurement- *increased conjugated bilirubin level*. Light-colored stools causes by absence of bile.

Prehepatic jaundice

"Before the liver" Result of the *excessive destruction of red blood cells*. Characteristic of hemolytic anemias or transfusion reactions. Bilirubin measurement- *Unconjugated bilirubin level elevated*

Pyrosis

"Heartburn" Esophageal pain

Intrahepatic jaundice

"In the liver" Occurs with *disease or damage to hepatocytes* -> Hepatitis or Cirrhosis. R/t impaired uptake of bilirubin from the blood. Bilirubin measurement - *Both unconjugated and conjugated bilirubin* levels may be elevated.

Functions of the liver (picture)

"Metabolic factory" of the body. Bile salt secretion for fat digestion. Temporary storage of blood (can empty during shock, trauma, hypovolemia). Removal of bilirubin from the bloodstream. Excretion of bile pigment and cholesterol. Urea formation. Detoxification (Kupffer cells) Metabolism

Diverticula

(Single- Diverticulum) A herniation or outpouching of the mucosa and submucosa through the muscular layer of the bowel (colon wall- frequently the sigmoid colon). Usually multiple, frequently on the left side (descending). Causes- increased pressure (constipation), lower fiber intake. Symptoms- asymptomatic, mild discomfort, change in bowel habits (diarrhea or constipation), increased gas/flatulence.

Metabolic function of the liver-

*Carbohydrate, protein, and lipid metabolism.*- Sugars -> glucose homeostasis, stored as glycogen, excess carbs used to make fat. Proteins-> synthesis and degradation, secretes albumin, ammonia made into urea. Fats-> oxidized for energy keto-acids; synthesis of cholesterol, phospholipids, and lipoproteins; triglyceride formation from carbs and protein. *Drug and hormone metabolism*- Biotransformation into water-soluble forms. Detoxification or inactivation.

S/S of acute pancreatitis

*Cardinal sign- Steady, boring pain in epigastrium or LUQ radiating to the back. Pain increases when individual assumes a supine position*. Severe tenderness on palpation, radiates/penetrates to back. Abdominal distention. Low-grade fever. Tachycardia and hypotension (shock). Respiratory distress.

Causes and S/S of a Hiatal Hernia

*Causes*- Shortening of the esophagus. Weak diaphragm. Increased abdominal pressure (r/t pregnancy, third spacing). Chronic GERD. *S/S*- Heartburn (pyrosis). Frequent belching. Increased discomfort when laying down. Dysphagia. Substernal pain after meals.

Causes, possible complications, and S/S of Peptic ulcer disease (PUD)

*Causes*- H. pylori, inadequate blood supply, stress, smoking, alcohol, spicy foods, genetics, medications, chronic gastritis. *S/S*- epigastric, burning pain. Relieved by eating, heartburn, A/N/V, weight loss, anemia, occult stools. *Complications*- hemorrhage, perforation, obstruction.

Diagnosis, symptoms, and treatment for Celiac disease

*Diagnosis*- - Intestinal biopsy - Blood tests-> Anti-tissue transgluteminase antibody (anti-ttg), Immunoglobulin A (IgA) endomysial antibody. *Symptoms*- - Steatorrhea (oily, smelly stools) - Muscle wasting - Weight loss - Irritability, malaise *Treatment*- - Gluten free diet - Supplemental Iron, folate, b12, fat-soluble vitamins.

Fluid and electrolyte imbalances

*Electrolytes*- esp sodium, are lost in vomit and diarrhea. Diarrhea leads to significant losses of potassium ions.

Different types of blood in stools

*Frank blood*- red blood, often on the surface of the stool. Usually results from lesions in the rectum or anal canal. *Occult blood*- small, hidden amounts of blood that are not visible to the eye but are detectable on tests of the stool sample. May be caused by small bleeding ulcers in the stomach or small intestine. *Melena*- dark-colored (tarry) stool that results from significant bleeding that has occurred higher in the digestive tract. The hemoglobin has been acted on by intestinal bacteria, causing the dark color.

Initial functional losses in persons with cirrhosis include-

*Hematologic disorders*- Anemia, thrombocytopenia, coagulation defects (easy bruising), leukopenia. *Endocrine disorders*- Fluid retention, hypokalemia, altered sexual functions, impaired glucose metabolism. *Skin disorders*- Jaundice, red palms, spider nevi. *Hepatorenal syndrome*- Azotemia (buildup of waste products in the blood), increased plasma creatine, oliguria (impaired conversion of ammonia to urea). *Hepatic Encephalopathy*- Complex neuropsychiatric syndrome- associated with hepatic failure or severe chronic liver disease. *Digestive*- Decreased bile production, malnutrition.

Manifestations of advanced cirrhosis-

*Portal hypertension* (b/c of the pressure in the liver- blood can't flow through) *Ascites* (third-spacing), *peripheral edema Splenomegaly Esophageal varices* (veins around the esophagus enlarge)- may rupture, leading to hemorrhage, circulatory shock) *Jaundice, encephalopathy* (buildup of waste and fluid)

Advanced functional losses in persons with cirrhosis include-

*Portal hypertension*- increased resistance in the portal venous system and sustained increase in pressure. Three common complications- *Ascites*- accumulation of fluid in the abdomen (third spacing). S/S- shortness of breath, fluid wave, pain, low albumin. *Splenomegaly*- enlarged spleen -> hemolysis -> anemia, leukopenia. *Esophageal Varices*- abnormal enlarged veins around the esophagus. Can be life threatening when they rupture. Leads to hematemesis (blood in vomit), melena (dark, tarry stools), occult stools.

S/S and Complications of Appendicitis

*S/S*- Abrupt RLQ + periumbilical pain, tenderness - McBurney's point. Nausea and vomiting Fever Diarrhea Systemic signs of inflammation - low grade fever, leukocytosis *Complications*- Sepsis- because it rupture Peritonitis

S/S, diagnosis, and treatment for IBS

*S/S-* Fluctuations in stool frequency and consistency. Abdominal pain, fullness, bloating, gas, nausea. Abdominal cramping relieved by defecation. *Diagnosis*- s/s and full structural + metabolic analysis. *Treatment*- no single cure. Treat the symptoms.

S/S and Complications of Crohn's disease

*S/S-* Intermittent bouts of fever Soft, semi-formed diarrhea RLQ pain Anorexia, weight loss, fatigue Anemia Growth delay in children *Complications*- Deficiencies (b/c it affects the small intestine)- malnutrition, protein, vitamin A + D. Obstructions (b/c of narrowing) Ulcerations, strictures, and fistulas

Types of IBS

- *Diarrhea/Constipation IBS->* abnormal motility and secretion of serotonin. - *Visceral hypersensitivity->* causes increased sensitivity to visceral pain. Abnormal motility and pain due to activated mast cells and T lymphocytes. - *Postinfectious IBS->* associated with bacterial enteritis (short term- food poisoning) or abnormal immune response (long-term) - *Overgrowth of flora->* causes increased gas production, bloating, and may cause constipation. - *Food allergy/intolerance->* activated immune response, hypersensitivity response. - *Psychosocial->* causes by emotional stress, abnormal autonomic response. Most common

Common manifestations of digestive system disorders-

- Anorexia, Nausea, vomiting (A/V/N) - Diarrhea - Constipation - Hemorrhage - Pain

Common therapies and preventions-

- Dietary modifications. - Stress reduction. - Drugs/Medications -> antacids, antiemetics (relieve vomiting), laxatives or enemas, antidiarrheals, antibacterials, histamine2 blockers, proton pump inhibitors.

Bilirubin measurements

- Direct/Conjugated bilirubin measured in blood. - Total bilirubin measured in blood. - Indirect/Unconjugated bilirubin = total bilirubin minus direct bilirubin.

Common issues of digestive system disorders-

- Fluid and electrolytes imbalances - Malnutrition

Pathophysiology of an intestinal obstruction

- Mechanical obstruction occurs. - Gases and fluids accumulate proximal to the blockage, distending the intestine. - Increasing contractions occur in an effort to move the contents onward. - Increasing pressure in the lumen causes edema and leads to more secretions entering the intestine and compresses the veins in the wall (stops blood flow to intestines). - Intestinal distention leads to vomiting, fluid and electrolyte imbalances, and changes in bowel sounds. - If unresolved- intestinal wall becomes ischemic and necrosis. Gangrene and perforation may occur.

Basic diagnostic tests-

- Radiography- placement, size, structures. - Ultrasound- masses. - Computed tomography (CT)- position, masses, tears. - Magnetic resonance imaging (MRI)- tendons, ligaments. - Fiberoptic endoscopy- visual, biopsy. - Sigmoidoscopy and colonoscopy- visual, biopsy. - Stool and blood specimens- O&P (ova and parasite), bleeding, malabsorption, function.

Alcoholic liver and Portal cirrhosis stages-

1. *Initial stage: Fatty liver*- Enlargement of the liver due to fat deposits. Asymptomatic and reversible with reduced alcohol intake. 2. *Second stage: Alcoholic Hepatitis*- Inflammation and cell necrosis occurs. Fibrous tissue forms, an irreversible change. May be asymptomatic or manifest with mild symtoms (A/N, liver tenderness). 3. *Third stage: End-stage cirrhosis*- Fibrotic tissue replaces normal tissue. Little normal functions remains, loss of 80-90% of cell function.

Stages of viral hepatitis

1. *Preicteric stage*- Very vague- fatigue and malaise, anorexia and nausea, general muscle aching. 2. *Icteric stage*- Onset of jaundice, stools light in color, urine becomes darker, liver tender and enlarged (hepatomegaly), mild aching pain. 3. *Posticteric stage*- recovery stage- Reduction in signs- jaundice and fatigue lower, liver function improves. Weakness persists for weeks

The pathophysiologic effects of cirrhosis evolve from these two factors-

1. The loss of liver cell functions. 2. The interference with blood and bile flow in the liver.

Irritable bowel syndrome (IBS)

A GI disorder with manifestations of abdominal pain/discomfort, and changes in normal bowel habits. Types of IBS are identified based on the primary symptoms of diarrhea, constipation, and/or pain.

Cirrhosis

A disorder in which there is progressive destruction of liver tissue eventually leading to liver failure. *Causes->* Alcoholic liver disease, Biliary cirrhosis, Postnecrotic cirrhosis, Metabolic. Diagnosed via liver biopsy and serologic testing. *Pathophysiology->* liver demonstrates extensive diffuse fibrosis and loss of lobular organization. Interferes with blood supply and bile back up, leading to ongoing inflammation and damage. Degenerative changes occur- atrophy.

Mesentery

A double layer of peritoneum that supports the intestines and coveys blood vessels and nerves to supply the wall of the intestine.

Intestinal obstruction

A lack of movement of the intestinal contents through the intestine. Obstructions are more common and occur more rapidly in the small intestine due to its smaller lumen. May have an acute (ex- twisting) or gradual (ex- tumor) development. Two types- Mechanical or Paralytic

Bowel distention

A potentially lethal condition due to lumen distention crushing the blood vessels feeding the gut wall and mesentery. Causes- blunt abdominal trauma, sepsis, increased pressure. Concerns- hypoperfusion leading to ischemia; release of cytokines, formation of oxygen free radicals, and decreases cellular production of ATP.

Toxic or Nonviral Hepatitis

A variety of hepatotoxins, such as chemicals or drugs, may cause inflammation and necrosis in the liver. Results due to direct effect of toxins. May result from sudden exposure to large amounts of a substance or from long-term exposure. Hepatotoxic drugs include- acetaminophen, halothane, phenothiazines, tetracycline. Toxic chemicals include- carbon tetrachloride, toluene, ethanol. Symptoms and phases are similar to viral hepatitis.

If vomiting is severe, there is a change to metabolic ____________.

Acidosis Duodenal secretions containing large quantities of bicarbonate ion are lost, ketoacidosis develops owing to a glucose deficit, and lactic acid accumulates as a result of hypokalemia and impaired tissue perfusion as well as increased muscle activity, which all lead to acidosis.. May also accompany severe diarrhea

Acute Cholecystitis

Acute inflammation of the gallbladder. *S/S*- abdominal pain + tenderness, A/N/V, mild fever, RUQ pain, may radiate to back or right shoulder. *If untreated* - gangrene, peritonitis, septic shock (if it ruptures), localized abscess, cholecystoenteric fistula

Hepatitis D

Aka delta virus Requires Hep B to replicate and produce active infection. Transmitted by blood, high incidence in IV drug users. Could go into carrier state with Hep B

Initially vomiting leads to metabolic ___________.

Alkalosis, due to the loss of Hydrogen ions with vomiting.

Ulcerative colitis

An *autoimmune response causing ulcers within the colon and rectum*. Starts in the colon and then ascends. The mucosa and submucosa inflame causing ulceration and the surrounding tissue to become edematous and friable. Granulation tissue that heals over the area but it is very vascular, fragile, and bleeds easily. This tissue destruction interferes with the absorption of fluid and electrolytes in the colon. Long-term UC leads to an increased risk of colorectal carcinoma. In severe acute episodes toxic megacolon may develop.

Stricture

An abnormal narrowing of a canal or duct in the body.

Diarrhea

An excessive frequency of stools, usually of loose or watery consistency, and may be acute or chronic. Types- *Large volume*- watery, frequent. Ex- infection, food poisoning, lactose intolerance. *Small volume*- little bits, very often. May contain blood, mucus, or pus. Ex- inflammatory bowel diseases- IBS, UC. *Steatorrhea*- greasy stools, bulky, foul oder. Ex- malnutrition disorders- celiac, CF. Symptoms- cramping pain Complications- dehydration, F/E imbalances, acidosis, malnutrition.

Acute pancreatitis

An inflammation of the pancreas resulting from autodigestion of the tissues. The autodigestion follows *premature activation of the pancreatic enzymes* within the pancreas itself. Considered a medical emergency. Predisposing factors- - Biliary reflux (b/c *gallstones* blocking duct). - Biliary tract disease - Hypertriglyceridemia - *Ethanol-associated* (66%)

What is a possible cause of pyelonephritis?

Ascending infection of E. coli

Visceral pain

Associated with the autonomic nervous system -> sweating, pallor, N/V tachycardia. Difficult to localize. Burning, dull, cramping, colicky

S/S of Cholelithiasis

Asymptomatic (until obstruction). Colicky pain (intermittent, RUQ. Can radiate to shoulder). Pain often precipitated by a meal. Nausea, vomiting, gas. Sweating.

What does the pathophysiology of chronic gastritis include?

Atrophy of the gastric mucosa

What causes massive inflammation and necrosis in acute pancreatitis?

Autodigestion of tissue by pancreatic enzymes

Why are the peritoneal membranes useful as an exchange site for blood during peritoneal dialysis in patients with kidneys failure?

Because the serous membranes of the peritoneum are thin, somewhat permeable, and highly vascular.

Yellow- or greenish-stained vomitus usually contains-

Bile from the duodenum.

Ruby has had a history of black tardy stools. This is indicative of- Constipation Blood in stool Malnutrition Renal colie

Blood in stool

Similarities between Crohn's disease and Ulcerative Colitis?

Both have- Inflammation Idiopathic cause Systemic manifestations Familial occurrence Remissions and exacerbations

Sinusoids

Channels filled with blood that pass between the plates of hepatocytes in the liver. Lined with endothelial cells and Kupffer cells which remove and phagocytize any foreign material and bacteria from the digestive tract before the blood enters general circulation.

Somatic pain

Characterized by a steady, intense, often well-localized pain. Due to pressure over the inflamed area- parietal peritoneum. "Rebound tenderness" May lead to reflex spasm of the overlying abdominal muscles, which leads to a ridges abdomen or "guarding."

Chronic gastritis

Characterized by atrophy of the mucosa of the stomach, with loss of secretory glands and parietal cells (therefore lack of intrinsic factor-> decreases b12 absorption). Causes- *Helicobacter pylori* (H. pylori), autoimmune, alcohol abuse. S/S- vague- Mild pain, anorexia, food intolerance. Complications- peptic ulcer, cancer, anemia (r/t bleeding)

A deeper brown color of vomitus may indicate-

Content from the lower intestine, typical of recurrent vomiting in persons with intestinal obstruction.

Treatment for Cirrhosis

Correct the manifestations of cause- - Alcohol - Dietary supplements - Fluid and electrolyte imbalances - Medications - Liver transplant

What are the two types of chronic inflammatory bowel disease (IBD)?

Crohn's disease and Ulcerative Colitis

_______________ and _____________ are common complications of digestive tract disorders.

Dehydration; hypovolemia

Chronic pancreatitis

Destruction and necrosis of large portions of the exocrine pancreas, leading to fibrosis. *Predisposing factors-* - ETOH consumption - Idiopathic - Hereditary - Autoimmune *Signs/Symptoms-* - Bouts of acute pancreatitis - Insidious onset of epigastric pain radiating to the back. - Endocrine and exocrine pancreatic insufficiency. - Weight loss - A/N/V

Dysphagia

Difficulty swallowing, inability, or sticking sensation. Causes- Neurological- stroke, brain injury Muscular- muscular dystrophy Mechanical- stenosis/stricture, congenital, tumors, diverticula, fibrosis.

Diverticulitis

Diverticula become inflamed. *Symptoms*- LLQ cramping or steady pain and tenderness with nausea and vomiting. Slight fever. Change in bowel habits. *Complications*- Perforation, hemorrhage, obstruction, fistula.

Three sections of the small intestine (proximal to distal)

Duodenum Jejunum Ileum

Diarrheal diseases are collectively referred to as-

Enterocolitis

Achalasia

Failure of the lower esophageal segments (LES) to relax. Food stasis develops/collects above the LES. Causes regurgitation and vomiting.

Hepatitis A is transmitted via the ________________ route.

Fecal-oral

Vomiting (emesis)

Forceful oral explosion of gastric contents (chyme) from the stomach or sometimes intestines. Considered a body defense because it removes noxious substances from the body. Coordinated by the vomiting center in the medula- Triggers- distention, irritation, sights, smells, pain, inner ear, stress, neuro, drugs/toxins Manifestations- dizziness, bradycardia, hypotension r/t not breathing while vomiting.

Symptoms of Ulcerative Colitis

Frequent watery diarrhea with blood and mucous, accompanied by cramping pain. Tenesmus (persistent spasms of the rectum associated with a need to defecate). Severe anemia r/t rectal bleeding. Absorption issues- mainly water. Fever + weight loss.

Recurrent vomiting of undigested food from previous meals indicates a problem with-

Gastric emptying, such as pyloric obstruction.

The liver responds to high levels of blood glucose by-

Glycogenesis (converting glucose to glycogen), which is stored in the liver.

Stimulation of the parasympathetic nervous system results in-

Increased motility (peristalsis) and increased secretions in the digestive system.

Viral hepatitis

Infection causing inflammation and necrosis of the liver. Agent- group of viruses directly affecting the hepatocytes. Hepatitis A, B, C, D, or E. Differ in- Transmission, incubation period. Mechanisms, degree, and chronicity of liver damage. Ability to evolve to a carrier state (get passed on). Virus damages the *liver cells directly* or damage can be caused by an *immune response*. Cell damage causes inflammation and necrosis- degrees may vary.

Typical changes of Crohn's includes-

Inflamed areas of the mucosal layer leading to thicker nodules

Appendicitis

Inflamed, swollen, or gangrenous appendix. Most common in young adults (ages 20-30). Commonly fluid builds up and microorganisms proliferate, walls inflame and bacteria escape to surrounding tissue. Can rupture or abscess. Causes- - Obstruction by a fecalith, gallstone, or foreign material, or from twisting or spasm.

Peritonitis

Inflammation of peritoneal membranes. May result from chemical irritation (bile, chyme, or foreign objects) or directly from bacterial invasion. S/S- abdominal distention, rigid/board-like abdomen, abdominal muscle spasms, sudden severe generalized abdominal pain. Vomiting. Signs of dehydration and hypovolemia.

Cholecystitis

Inflammation of the gallbladder wall and cystic duct. May be acute or chronic. Causes- Cholelithiasis (gallstones) present in 90% of patients. Obstruction of cystic duct present in almost all patients. Bacterial infection (E.coli) may be present. Diagnosis- ultrasound

Hepatitis

Inflammation of the liver. May be idiopathic (fatty liver) or result from a local infection (viral hepatitis), from an infection elsewhere in the body, or from a chemical or drug toxicity. Ranges from mild to severe.

Crohn's disease (Regional ileitis or Regional enteritis)

Inflammation of the mucosal layer that progresses to *all layers* of the intestinal wall. Inflammation occurs in a characteristic distribution called *"skip lesions"*, with affected segments clearly separated by areas of normal tissue. Can occur anywhere in the digestive tract.

Gastritis

Inflammation of the stomach (gastric mucosa) that can occur in many forms. Mucosa becomes red and edematous (instead of pink and shiny). Can range from simple irritation to hemorrhage. May be acute or chronic.

Pathophysiology of Crohn's disease

Inflammation within the mucosal layer causes shallow ulcers. Ulcers tend to have thickened elevations or nodules between them, giving it the wall a cobblestone or skip lesion appearance. This progressive inflammation can eventually affect all layers and lead to granulomas.

Gastrointestinal Reflux Disease (GERD)

Involves the periodic flow (reflux) of gastric contents into the esophagus. *Causes*- weak lower esophageal sphincter (LES), gastric distention, delayed gastric emptying. *Irritants*- caffeine, alcohol, smoking, sleeping, position, medication, hiatal hernia, spicy food. *Symptoms*- commonly occurs 30-60 minutes after eating or lying down. Burning sensation, spasms, heartburn, chest pain. If untreated-> ulceration, scarring, strictures, cancer.

Peritoneum

Large double-layered serous membrane in the abdominal cavity. Parietal covers the abdominal wall and surface of the urinary bladder + uterus. Visceral encases the organs. Useful as an exchange site for blood during peritoneal dialysis.

Ulcerative colitis most commonly affects the _________ intestine, while Crohn's disease most commonly affects the _________ intestine.

Large; small

Constipation

Less frequent bowel movements than normal. Acute or chronic problem. Usually a movement (peristalsis) issue. Symptoms- abdominal pain, sensation to defecate. If severe- hemorrhoids, fissures, diverticulosis/itis, fecal impaction and intestinal obstruction.

Pancreas

Lies posterior to the stomach, with its larger end or "head" adjacent to the duodenum. Exocrine organ. Cells are arranged in lobules; they secret digestive enzymes, electrolytes, and water. Secrets major proteolytic enzymes (ex- trypsin, ribonuclease). Pancreatic amylase aids carbohydrate digestion, and lipase helps digest fats. Enzymes are secreted in an inactivated form.

Hepatocytes

Liver cells arranged in lobules Each lobule has plates of cells radiating from central veins, which eventually drain blood black into the central circulation through the hepatic veins and inferior vena cava.

Hepatitis B

Long incubation period and a carrier/chronic state is common. Transmitted primarily through blood, but sexual transmission is possible. Healthcare workers, tattoo artists, and IV drug users are at risk. Vaccine is available. Can resolve spontaneously or with medication.

Anorexia

Loss of appetite Often precedes nausea and vomiting. Factors that play a part- emotions, disease, pregnancy, smells, drugs/medications.

Malnutrition

May be limited to a specific nutrient, or may be general and have many causes related to GI function. Common specific types- Vitamin B12 deficiency. Iron deficiency. General malnutrition may result from chronic A/V/D. Other systemic causes- Chronic inflammatory bowel disorders Cancer treatments Wasting syndrome Cystic Fibrosis Lack of available nutrients (fad diets, poverty, obesity)

Peptic ulcer disease (PUD)

Most common - Gastric ulcers (stomach) and duodenal ulcers. Appear as single, small, round cavities with smooth margins that penetrate the submucosa. The acid or pepsin penetrates the mucosal barrier, this exposes the tissue causing deeper penetration through muscle and eventually could perforate the wall. Tissue around the cavity becomes inflamed. When the erosion invades a blood vessel wall, bleeding will occur (may involve persistent loss of small amounts of blood or massive hemorrhage).

Hepatitis C

Most common type of hepatitis transmitted by blood transfusions. Approx half of cases enter a chronic disease state. May exist in a carrier state. Varying genotypes and subtypes.

Pyloric stenosis

Narrowing and obstruction of the pyloric sphincter (between the stomach + small intestine). May be a developmental anomaly present at birth *or* May be acquired later in life due to scarring. S/S- persistent feeling of fullness, increased incidence of vomiting with it after meals (with force). Surgery is required to remove obstruction or stricture.

Initial manifestations of cirrhosis-

Often mild and vague Fatigue, anorexia, weight loss, anemia, diarrhea Dull aching pain in URQ (b/c of liver enlargement) Bruising

Anatomy of the digestive system with associated events (picture)

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Types of jaundice (picture)

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Common manifestations of Liver disease (picture)

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Crohn's disease vs Ulcerative colitis (picture)

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Referred pain

Pain is perceived in an area distant from its point of origin. Results when somatic and visceral nerves converge at one spinal cord level.

Hiatal hernia

Part of the stomach protrudes through the opening (hiatus) in the diaphragm into the thoracic cavity. Two types- *Sliding*- more common. Portion of the stomach and gastroesophageal junction slide up. *Rolling*- part of the fundus of the stomach moves up. Blood vessels in the wall of the stomach may be compressed, leading to ulceration. Both can cause foods caps, reflux, and esophagitis.

Duodenal ulcers

Peptic ulcers in proximal duodenum Most common Pain 2-3 hours after meals Food may *relieve* pain.

Gastric ulcers

Peptic ulcers that occur in the stomach. Results in vomiting, weight loss. Pain 1/2 - 1 hour after meals. Eating may *increase pain*.

Andrew suffered from an intestinal perforation because of an obstruction. He is at risk for _______________.

Peritonitis

Chronic Cholecystitis

Persistent low-grade irritation, r/t recurrent attacks of acute cholecystitis. Predisposing factors- diabetes, obesity, gallstones (cholelithiasis). S/S- Vague Periodic episodes of pain-> epigastric or RUQ, radiating to the back. N/V, bloating, flatus Sweating Fat intolerance Complications- biliary sepsis, scarring

What is the primary cause of esophageal varices?

Portal hypertension

Bile

Produced by the liver, stored in the gallbladder. Essential for the emulsification of fats and fat-soluble vitamins (A, D, E, and K). Vital for digestion Serves as a vehicle for the removal of bilirubin and excess cholesterol from the body.

If hemorrhage is extensive, what color of blood would be obvious in the vomitus?

Red

Stress ulcers

Result from severe trauma, such as burns or head injuries, or occur with serious system problems, such as hemorrhage or sepsis. Cushing's ulcer = brain injury Curling's ulcer = extensive burns *Hemorrhage* -> keep an eye on hemoglobin levels. Lots of bleeding = shock.

Mechanical intestinal obstruction

Results from hernias, tumors, adhesions, intussusception (telescoping- goes inside self), or impactions.

Paralytic intestinal obstruction

Results from neurological or muscular impairment of peristalsis. Conditions that decrease peristalsis-> narcotics, anesthesia, surgery, spinal cord injuries.

Acute gastritis

Self-limiting, area heals/regenerates quickly, treatment is supportive. *Causes*- ingestion of irritating substances (hot, spicy foods; corrosive or toxic substances), infection, allergies, alcohol, medications (ulcerogenic, aspirin, NSAIDs), radiation/chemotherapy. *S/S*- hematemesis (vomiting blood), A/N/V, postprandial discomfort (pain after eating).

S/S of an intestinal obstruction

Severe colicky abdominal pain Increased, high pitched bowel sounds, or totally absent BS. N/V Abdominal distention No stools or passing of gas

Hepatitis E

Spread by the fecal-oral route Lacks a chronic or carrier state Common in third world countries, produces a high mortality rate in pregnant women.

Gluconeogenesis

The conversion of protein or fat into glucose

Cholelithiasis

The formation of *Gallstones* (masses of solid material or calculi that form in the bile). Vary in size and shape and may form initially in the bile ducts, gallbladder, or cystic duct. Causes- Abnormal composition of bile (too much cholesterol, bilirubin, or calcium and too little bile salts). Stasis of bile. Inflammation of the gallbladder. Other factors- obesity, rapid weight loss, gender (women).

Celiac disease

The intolerance of gluten containing foods- weight, barley, oats, rye. A malabsorption syndrome. 2x increase for intestinal malignancy. Patho- - A defect in the intestinal enzyme that breaks down gliadin (a component of gluten). - An *immunological response* occurs with the blockage of this breakdown causing a *toxic effect on the intestinal villi*. - The villi atrophy resulting in less surface area and a decrease in normal enzyme production, this causing malabsorption and malnutrition.

Gastroenteritis

The involvement of the stomach and the intestines in the inflammatory process. Usually caused by infection, but may be an allergic reaction to food or drugs. S/S- N/V, abdominal cramps, fever, malaise. Careful hand washing and food handling can reduce outbreaks. Possible infectious causes- Clostridium difficile (C. diff), Escherichia coli (E. coli)

Hematemesis

The presence of blood in vomitus resembling "coffee grounds". A brown, granular material resulting from the partial digestion in the stomach of protein in the blood.

The liver is located in the-

Upper right quadrant (URQ) of the abdomen under the diaphragm.

Causes of constipation include-

Weakness of smooth muscle in the intestine b/c of age or illness. Inadequate dietary fiber or fluid intake. Failure to respond to defecation reflex b/c of pain or inconvenient timing. Immobility- muscle weakness and inactivity. Neurological disorders (MS, spinal cord trauma). Drugs (ex- opiates, antacids, iron medicatuons). Obstruction caused by tumor or strictures.

Jaundice (icterus)

Yellowish tinting of the skin and tissue due to excessive amounts of bilirubin in the blood. First seen in the sclera of the eyes. Three common disorders associated with jaundice-> Pre, post, and intra hepatic. The type of jaundice present in an individual are indicated by an increase in the serum bilirubin levels and changes in the stool.

Hepatitis A

aka infectious hepatitis Transmitted via contaminated food and water supplies (*fecal-oral route*). People that travel abroad are at risk. Short incubation period. Causes an acute but self-limiting infection and does not have a carrier or chronic state. There is a vaccine available .

Nausea

ill-defined, subjective, unpleasant feeling. May be stimulated by distention, irritation, or inflammation in the digestive tract. Preceded by autonomic responses- salvation, sweating, pallor, tachycardia