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Unit 4: Pathophysiology
Gastrointestinal
21
Nursing
Undergraduate 2
04/21/2010

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Cards

Term

 

 

Manifestations of GI tract disorders

Definition

Dysphagia

Esophageal Pain

Abdominal Pain

Vomiting

Intestinal Gas

Alternations in Bowel Patterns:

Constipation

Diarrhea

Term

 

 

Gastroesophageal Reflux

(GERD)

Definition

Backflow of gastric contents into esophagus through LES.

Etiology: Pregnancy, Obesity, Smoking, Fatty foods, ETOH, caffeine, chocolate, hiatal hernia, medications

S/S: heartburn, regurgitation, CP, belching, reflux esophagitis

Tx: Inc. LES closing pressure, improve gastric emptying, dec. gastric acidity

Lose weight, sm meals (not before bed) elevate HOB, antacids

Potential Complication: Barrett esophagus: histological changes.

Term

 

 

Peptic Ulcer Disease

Definition

Disorders of GI tract caused by acid and pepsin

Usually in stomach or duodenum.

Etiologies: breakdown of gastric mucosal barrier, excess secretion of acid (duodenal), H pylori.

S/S: epigastric pain that goes away with eating, hematemesis, melena, hemoptysis

Tx: Reduce gastric acidity, eradicate H pylori w/ antibiotics

Avoid smoking, NSAIDS, stress, ETOH, caffeine

Term

 

 

Ulcerative Colitis

Definition

Inflammatory disease of colon and rectum.

Btwn 15-30 yrs and 50-70 yrs.

Smoking dec. risk of developing UC

Starts in rectum and moves up.

Disease of the mucosa of unknown origin

Inflam. of crypts of Lieberkuhn, invasion of leukocytes, abscesses form, ulceration develops.

S/S: abdom. pain, diarrhea, rectal bleeding

65-75% experience exacerbations and remissions

Tx: corticosteroids, broad spectrum antibiotics.

Term

 

 

Crohn Disease

Definition

Inflammatory disease extending through all layers of intest. wall

Age: >30 yrs.

Most commonly affects proximal colon and terminal ileum.

Results from a blockage of lymphatic structures.

S/S: perianal fissures, fistulae, abscesses, RLQ abdom pain, diarrhea, vomiting, wt loss, dec H+H

Tx: reduce and alleviate inflammation. Antibiotic metronidazone is paticularly useful.

Smoking inc. risk

Potential complication: perforation peritonitis.

Term

 

 

Appendicitis

Definition

 

 

Etiology: unknown. Most likely blockage of appendiceal lumen.

S/S: waves of periumbilical pain, nausea, pain becomes steady, rebound tenderness, guarding.

Tx: appendectomy.

Term

 

 

Diverticula

Definition

 

 

Herniation of mucosa and submucosa into the colon wall.

Term

 

 

Diverticulosis

Definition

 

Presence of diverticula in the colon.

Etiology: low fiber diet.

80% of 80 year olds have this.

Asymptomatic.

Develop in areas of high intralumen pressure.

Tx: high fiber diet, bran, bulk laxatives.

Term

 

 

Diverticulitis

Definition

 

Inflammation of the diverticula

Can lead to abscesses in the bowel wall, peritonitis and intestinal obstruction.

S/S: LLQ abdom. pain, fever, leukocytosis, constipation common, anorexia, flatus, mucus or blood in stools.

Tx: rest bowel, NPO, NGT to sxn, IV fluids and antibiotics, surgery

Term

 

 

Intestinal Obstruction

Definition

Partial or complete blockage of the lumen of the sm/lg intestine.

Mechanical: adhesions, hernia, tumor, inflam, impacted feces

Functional: loss of propulsive ability by the bowel.

S/S: reverse peristalsis, dehydration, pain, constipation, gas distention, electrolyte imbalance, raised diaphragm

Tx: decompress the bowel: insertion of intestinal tube, surgery for mechanical. For functional, rest the bowel, prevent distention w/ gastric suction.

Term

 

 

Intussusception

Definition

 

Telescoping or invagination of a portion of the bowel into an adjacent distal portion.

Most common in infants.

Has been linked to viral infections.

As a bowel segment undergoes intussusception, peristalsis acts to pull more bowel along w/ it.

Tx: surgery.

Term

 

 

Cholelithiasis

Definition

 

 

Gall stones in the gall bladder

Term

 

 

Chloledocholithiasis

Definition

 

 

Stones in the common bile duct

Term

 

 

Cholangitis

Definition

 

 

Inflammation of the common bile duct

Term

 

 

Acute Cholecystitis

Definition

Inflammation of the gall bladder wall.

Risk factors: cholelithiasis, age, female, obese, rapid wt loss, pregnancy, Native American, spinal cord injury

Cystic duct clogs, bile stasis in gall bladder occurs, inflammation escalates, gall bladder may rupture.

S/S: RUQ pain, may radiate back, abdom. tenderness and fever, jaundice if CBD is blocked.

Tx: laparoscopic cholecystectomy, lithotripsy, antibiotics.

Term

 

 

Acute Pancreatitis

Definition

Etiology: ETOH abuse, gallstone obstruction, infections, toxins, heredity, structure abnormality, ischemia, pregnancy

Obstruction of pancreatic duct by stone or other cause w/ release of digestive enzymes within the parenchyma, followed by enzyme activation and autodigestion of pancreas.

S/S: steady, boring pain in the epigastrium or LUQ, gradully inc. in intensity, N/V, exquisite tenderness, fever, ascites, anxious

Tx: NPO, NGt to sxn, opioids, TPN, calcium, antibiotics, supportive care, ERCP.

Term

 

 

Acute Viral Hepatitis

Definition

 

Inflammation of the liver parenchyma

Liver inflam leads to necrosis and dec liver fxn.

S/S: jaundice, lethargy, malaise, myalgia, arthalgia, anorexia, N/V, abdom pain, diarrhea, constipation, fever, itching from bile salt accumulation.

Tx: Rest, nutrition.

Term

 

 

Hepatitis A

Definition

 

RNA virus spread by fecal-oral route.

S/S: often asymptomatic, malaise, anorexia, nausea, fever, RUQ pain, jaundice (sometimes absent in kids)

Tx: supportive, rest, nutrition avoid ETOH, NSAIDS, vaccination recommended for risk groups (foreign travelers, chronic active HBV or HCV, institutionalized persons)

Term

 

 

Hepatitis B

Definition

Partially double-stranded DNA virus highly prevalent worldwide.

Spread by parenteral contact with infected blood or blood products,  and sexual contact.

Incubation period: 2-6 months.

S/S: rashes, urticaria, joint pain, malaise, anorexia, nausea, fever, RUQ pain, jaundice

Tx: liver transplant, supportive.

Prevention: HBV vaccine.

Term

 

 

Hepatitis C

Definition

Single-stranded RNA virus.

Mode of transmission resembles HBV, sexual less likely. Mainly infected by IV drug use or blood transfusions.

Acute HCV usually asymptomatic. Mild if appear.

One of the most common causes of end stage liver disease.

Tx: supportive

Pts should be vaccinated against HAV and HBV.

Term

 

 

Cirrhosis

Definition

 

Widespread progressive fibrosis and nodule formation in liver.

Destruction of hepatocytes, scarring, dec liver fxn.

S/S: ascites, hematemesis, bleeding tendancy, prominent abdom. wall veins, internal hemorrhoids, confusion, irritability, infection, asterixis, inc in AST, ALT, LDH. dec in albumin.

Tx: nutritious diet w/ adequate calories and protein, vit supp, adequate rest. prevent infections, liver transplant.

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