Digestive Patho Exam #3

a lack of desire to eat despite physiologic stimuli that would normally produce hunger

forceful emptying of the stomach and intestinal contents through the mouth
several types of stimuli initiate the vomiting

a subjective experience that is associated with a number of condition
common symptoms of vomiting are hypersalivation and tachycardia

nonproductive vomiting

spontaneous vomiting that does not follow nausea or retching
caused by direct stimulation of the vomiting center by neurologic lesions of brain stem or gastrointestinal obstruction

infrequent or difficult defecation

neurogenic disorders, functional or mechanical conditions, low-residue diet, sedentary lifestyle, excessive use of antacids, changes in bowel habits

increased frequency of bowel movements
increased volume, fluidity, weight of the feces

a symptom of a number of gastrointestinal disorders
stretching and distention usually causes the pain

irritation of peritoneal lining

walls of an organ are stretched and nerves send signals to brain

feel pain somewhere else

upper gastrointestinal bleeding = esophagus, stomach, or duodenum
lower gastrointestinal bleeding = below the ligament of Treitz or bleeding from the jejunum, ileum, colon, or rectum

bloody vomitus; either fresh, bright red blood or dark grainy digested blood with "coffee grounds" appearance

black, sticky, tarry, foul-smelling stools caused by digestion of blood in the gastrointestinal tract

fresh, bright red blood passed from the rectum

trace amounts of blood in normal-appearing stools or gastric secretion; detectable only with guaiac test

difficulty swallowing

denervation of smooth muscle in the esophagus and lower esophageal sphincter relaxation
loss of esophageal peristalsis or failure of lower esophageal sphincter to relax

reflux of chyme from the stomach to the esophagus
causes inflammation of the esophagus = reflux esophagitis
normal functioning lower esophageal sphincter maintains a zone of high pressure to prevent chyme reflux

pregnancy

heartburn, regurgitation of chyme, and upper abdominal pain within 1 hour of eating

protrusion of the upper part of stomach through diaphragm into thorax
sliding hiatal hernia = can easily slide up and down
paraesophageal hiatal hernia = esophagus stays in place but the stomach slides

asymptomatic GER, dysphagia, heartburn, epigastric pain

blocking or narrowing of the opening between the stomach and the duodenum
acquired (disease) or congenital
peptic ulcer disease
carcinoma near pylorus

vague epigastric fullness
nausea, epigastric pain
anorexia (feels so full don't want to eat)
**vomiting** (cardinal sign of obstruction)
infrequent, small stools
prolonged: malnutrition, dehydration, debilitation

any condition that prevents the flow of chyme through the intestinal lumen
failure of normal intestinal motility in the absence of an obstruction lesion

failure of intestinal motility happening usually after abdominal surgery
prevents paristalsis

simple obstruction
functional obstruction

mechanical blockaged of lumen by lesion

failure of motility (paralytic ileus)

hernia
intussusception
torsion (volvulu)
diverticulitis
tumor
paralytic ileus
fibrous adhesions

vomitus

may turn malodorous with fecal smell
loss of electrolytes
hypovolemia
abdominal distention
constipation with failure to pass flatus
bowel sounds are increased and high-pitch at first then silent

inflammatory disorder of the gastric mucosa

erodes surface epithelium

occurs in elderly
thinning and degeneration of stomach wall

chronic fundal gastritis (Type A)
chronic antral gastritis (Type B)
^ different parts of the stomach

degeneration gastric mucosa
leads to gastric atrophy, loss of parietal cells
Helicobacter pylori promotes atrophy and tissue injury
risk factor for gastric carcinoma

4:1 occurrence over fundal
causative agent: Helicobacter pylori
mucosal atrophy rare

do not correlate with severity
vague
anorexia
fullness
nausea
vomiting
epigastric pain
gastric bleeding

a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum
acute and chronic ulcers
superficial = erosions
deep = true ulcers (down to the muscle)

smoking
advanced age
habitual use of NSAIDS
alcohol
chronic diseases such as emphysema, rheumatoid arthritis, cirrhosis, and diabetes
infection of the gastric and duodenal mucosa with H. pylori

most common of the peptic ulcers
occurs younger persons
developmental factors
hypersecretion of stomach acid and pepsin
inadequate bicarbonate secretion
high gastrin levels
acid production by cigarette smoking

H. pylori and NSAIDS

chronic intermittent epigastric pain
2-3 hours after eating

develop in the antral region of the stomach, adjacent to the acid-secreting mucosa of the body
males = females; 55 to 65 years old

the primary defect is an increase mucosal permeability to hydrogen ion
gastric secretion tends to be normal or less than normal

pain-food-relief; pain is often present after eating
anorexia, vomiting, weight loss
stools can look like coffee grounds

acute peptic ulcer that is related to severe illness, neural injury, or systemic trauma

bleeding
seldom become chronic

ischemic ulcers -> develop within hours of multisystem trauma
curling ulcer (type of ischemic ulcer)-> results from burn injury
**cushing ulcers -> associated with severe head trauma / brain surgery**

chronic inflammatory disease that causes ulceration of the colonic mucosa in the sigmoid colon and rectum
20 to 40 years of age

familial history
Jewish descent
Caucasians

intermittent remission and exacerbation
diarrhea (10 to 20/day), bloody stools, continuous cramping, urgency
dehydration, weight loss, anemia, fever
an increased colon cancer risk

inflammatory disease of large and small intestine
idiopathic inflammatory disorder; affects any part of the digestive tract, from mouth to anus
difficult to differentiate from ulcerative colitis
similar risk factors and theories of causation as ulcerative colitis

causes "skip lesions" (granulomatous)
ulcerations can produce longitudinal and transverse inflammatory fissures that extend into the lymphatics
anemia may result from malabsorption of vitamins B12 and folic acid

diarrhea; occasional colonic bleeding
weight loss; lower abdominal pain

herniations of mucosa through the muscle layers of the colon wall, especially the sigmoid colon

asymptomatic diverticular disease

the inflammatory stage of diverticulosis
don't eat corn because it can get into the holes

inflammation of the vermiform appendix
Epigastric pain and RLQ pain
vague then increases over 3 to 4 hours
rebound tenderness
nausea, anorexia, fever
**most serious complication is peritonitis**

obstruction, ischemia, increased intraluminal pressure, infection, ulceration, etc

functional GI disorder
affects 20% of population worldwide
women > men; increased incidence youth/middle-age
likely to have anxiety and depression
non-inflammatory exacerbations with stress

abdominal pain; altered bowel habits
alternating diarrhea/constipation, gas, bloating, nausea
symptoms relieved with defecation
does not interfere with sleep

irreversible inflammatory disease that disrupts liver function and even structure
leading cause of death in U.S.
decreased hepatic function caused by nodular and fibrotic tissue synthesis (fibrosis)

gallstones
stone formation -> cholesterol (most common), pigmented

obesity, middle age, female, rapid weight loss, NA ancestry, genetic predisposition

abdominal pain, jaundice (cardinal)
vague including heartburn, flatulence, epigastric pain, food intolerance (fats and cabbage)
pain often referred shoulder/scapula