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Gastrointestinal System
Exam 1
146
Pathology
Graduate
09/07/2011

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Term
Consists of upper and lower GI segments with separate functions
Definition
GI tract
Term
What all does the upper GI tract include?
Definition
Mouth
Esophagus
Stomach
Duodenum
Term
Purpose is to ingest and digest food
Definition
GI tract
Term
What all does the lower GI tract include?
Definition
Small
Large intestines
Term
Performs both digestion and absorption of nutrients
Definition
Small intestine
Term
Absorbs water and electrolytes, and stores feces until time for elimination.
Definition
Large intestine
Term
What are some signs and symptoms of GI problems?
Definition
Dyspepsia
Nausea and vomiting
Anorexia
Diarrhea
Constipation
Dysphagia
Achalasia
Heartburn
Abdominal Pain
GI bleeding
Bowel or fecal incontinence
Term
Hematemesis, melena, hematochezia
Definition
GI Bleeding
Term
Difficulty swallowing
Definition
Dysphagia
Term
Failure to relax the smooth muscle fibers of the GI tract, especially at the esophageal spinchter, resulting in obstruction to the passage of food thru the terminal esophagus. Results ina feeling of fullness in the sternal region and progressive dysphagia
Definition
Achalasia
Term
A burning sensation in the esophagus usually felt in the midline below the sternum, often the symptoms of gastroesophageal reflux
Definition
Heartburn
Term
Passage of tarry stools, due to the presence of blood altered by the intestinal juices
Definition
Melena
Term
Passage of bloody stools
Definition
Hematochezia
Term
Pain in the left shoulder caused by free air or blood in the abdominal cavity
Definition
Kehrs Sign
Term
Strenuous exercise can induce GI symptoms. Name 7
Definition
Heartburn
Belching
N&V
Abdominal cramps
Diarrhea
Fecal urgency
Term
Name 4 causes of abdominal pain
Definition
Mechanical
Inflammatory
Ischemic
Referred Pain
Term
Name 2 sites of pain that can be caused by GI bleeding, perforation associated with an ulcer, or a ruptured spleen.
Definition
Back and shoulder
Term
GI system pain should be ruled out for what other 2 types of pain
Definition
Musculoskeletal
CV disorder related
Term
Pain from __ or __ pain also can be referred to the abdomen; usually associated with hyperesthesia over the involved spinal dermatomes and the pain is intensified by motions such as coughing, sneezing, or straining.
Definition
Spine or neuromusculoskeletal
Term
Pain caused by __ diseases as such ischemic cardiac angina and aneurysm; these causes need to be ruled out.
Definition
CV
Term
Erosive gastritis is common in: (5)
Definition
1. Severely ill ppl with major trauma or systemic illness, burns, or head injury
2. Patients with peptic ulcers
3. NSAIDs users: aspirin or ibuprofen
4. Chronic alcohol user
5. Pts using anticoagulants: warfarin, heparin and aspirin used in the treatment of pulmonary emboli, venous thrombus or vavular abnormalities
Term
In developed countries, what are 5 common causes for vitamin deficiencies?
Definition
1. Chronic alcohol use
2. Medication misuse
3. Imbalanced diet
4. Foot faddism
5. Long term parenteral nutrition
Term
How are most vitamin deficiencies treated?
Definition
Vitamin replacement from diet to supplementation
Term
What is a common Vitamin A
Definition
Retinol
Term
A component of photoreceptor pigments int he retina and helps to maintain normal epithelium
Definition
Vitamin A
Term
Found in egg yold, butter, cream, liver, and fish liver oil. Also formed by the body from beta-carotene, which is found in yellow, orange, or leafy green vegetables.
Definition
Vitamin A
Term
Name 3 ways in which a person might develop a Vitamin A deficiency.
Definition
1. Night blindness, conjunctival dryness, and corneal keratinization, which may result in perforation.
2. Other signs include dry skin and keratinization of lung, GI, and urinary epithelium
3. Severe deficiency predisposes to increased infections. Deficiency is noted only after liver stores are depleted.
Term
What is a common Vitamin D
Definition
Calciferol
Term
Enhances calcium and phosphate absorption and helps maintain their appropriate levels in the blood
Definition
Vitamin D
Term
Found in yeast, fish liver oils, egg yolds, and supplemented dairy products: however, ourmajor source of this vitamin is its formation in the skin with sun exposure.
Definition
Vitamin D
Term
2 things that Vitamin D deficiency leads to.
Definition
1. Rickets in children and osteomalacia in adults
2. X-rays show several characteristic deformities, including long-bone bowing in children and demineralization in adults
Term
This vitamin maintains cell membrane integrity by protecting lipids from oxidation.
Definition
Vitamin E
Term
Found in vegetable oils, eggs, butter, and whole grains.
Definition
Vitamin E
Term
Deficiency of this vitamin is rare in a human.
Definition
Vitamin E
Term
There are 3 specific situations when a Vitamin E deficiency is likely to occur.
Definition
1. In persons who cannot absorb dietary fat - malabsorption syndroms with steatorrhea
2. In premature, very low birth weight infants (birth weights less than 1500 grams, or 3.5 pounds)
3. In individuals with rare disorders of fat metabolism
Term
Vitamin E deficiency can cause what 2 things?
Definition
1. Hemolysis, which may lead to anemia
2. Neurologic problems due to poor nerve conduction. These include neuromuscular problems such as spinocerebellar ataxia and myopathies
Term
This is a cofactor in the synthesis of clotting factors
Definition
Vitamin K
Term
This vitamin is supplied by leafy green vegetables and is also produced by normal intestinal bacteria
Definition
Vitamin K
Term
Deficiency of Vitamin K results in what 2 things?
Definition
1. Spontaneous bleeding or prolonged oozing
2. Prothrombin time (PT) is increased more than partial thromboplastin time (PTT), although both may be affected.
Term
What is the treatment for Vitamin K deficiency?
Definition
Injections of Vitamin K may be given if rapid correction of the deficiency is needed
Term
Name 4 fat soluble vitamins
Definition
A, D, E, and K
Term
Name 7 fat soluble vitamins.
Definition
B1, B2 Folate, B3, B6, B12, Folate, Vitamin C
Term
What is a common Vitamin B1?
Definition
Thiamine
Term
What is a common vitamin B3?
Definition
Niacin
Term
What is a common vitamin B6
Definition
Pyridoxine
Term
What is a common vitamin B12?
Definition
Cobalamin
Term
What is a common vitamin C?
Definition
Ascorbic acid
Term
This vitamin contributes to carbohydrate metabolism as a coenzyme.
Definition
Vitamin B1
Term
This vitamin is found in grains, but it is removed in the production of highly polished rice.
Definition
Vitamin B1
Term
Name 2 causes of Vitamin B1 deficiency
Definition
-Dietary deficiency of thiamine
-Certain conditions, including pregnancy and hyperthyroidism, increase the need for thiamine and can cause secondary deficiency
Term
Vitamin B1 deficiency can be manifested as: (3)
Definition
1. Painful bilateral, symmetric peripheral polyneuritis; called dry beriberi
2. Edema resulting from a high-output form of heart failure; called wet beriberi
3. The Wernicke-Korsakoff syndrome: also called cerebral beriberi
Term
Results in nystagmus, confusion, and confabulation may progress to coma and death. Occurs when chronic thiamine deficiency is exacerbated by acute defieiency. This condition is particularly common in alcoholics.
Definition
Wernicke-Korsakoff's Syndrome
Term
A componenet of the coenzymes flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN)
Definition
Vitamin B2 Folate
Term
Deficiency of riboflavin occurs with insufficient milk or animal protein consumption
Definition
Vitamin B2 Folate
Term
Vitamin B2 Folate defiency can manifest into what 4 things?
Definition
Cheilosis (swollen, cracked, bright red lips)
Angular stomatitis (fissuring at the angles of the mouth)
Cutaneous lesion (as dry and scaling skin, fluid retention in the mucus membranes)
Ocular lesions (eyes may become bloodshot, itchy, watery, and sensitive to bright light
Term
A coenzyme of carbohydrate metabolism
Definition
Vitamin B3
Term
Primary deficiency of this vitamin occurs when maize (milled corn) is a diet staple and secondary deficiency occurs with diarrhea, cirrhosis, alcoholism, and isoniazid (INH) use.
Definition
Vitamin B3
Term
Vitamin B3 deficiency can lead to what 2 things?
Definition
1. Pellagra, which is characterized by the "4 D's": diarrhea, dermatitis, dementia, and death
2. Symmetric cutaneous lesions, stomatitis, and glossitis
Term
Inflammation of the tongue
Definition
Glossitis
Term
This vitamin is active in blood, the CNS, and skin metabolism
Definition
Vitamin B6
Term
This vitamin is found in many foods, so deficiency is rare but may occur due to malabsorption or increased metabolism.
Definition
Vitamin B6
Term
Manifestations of Vitamin B6 deficiency include: (4)
Definition
-Seborrheic dermatosis, cheilosis, glossitis
-Peripheral neuropathy
-Lymphopenia, anemia
-May cause seizures in infants
Term
This vitamin is important for DNA synthesis and myelin formation.
Definition
Vitamin B12
Term
This vitamin is found in meat, eggs, and milk. Once ingested, it binds to intrinsic factor from the parietal cells, and the complex is absorbed.
Definition
Vitamin B12
Term
What are 2 causes of Vitamin B12 deficiency?
Definition
-Lack of B12 in diet
-Pernicious anemia, in which the destruction of parietal cells results in insufficient amounts of intrinsic factor
Term
What are 3 deficiency manifestations of vitamin B12?
Definition
Megaloblastic anemia
Neurologic disturbances
Ataxia
Term
What is the treatment for vitamin B12 deficiency?
Definition
Intramuscular injections of vitamin B12 for patients with pernicious anemia
Term
This is used in DNA synthesis and is found in leafy green vegetables and citrus fruits.
Definition
Folate
Term
Deficiency of this vitamin results from inadequate folic acid in diet, seen often in the elderly, alcoholics, and the poor.
Definition
Folate
Term
Signs of deficiency of this vitamin are often subtle. Megaloblastic anemia without neurologic changes suggests this diagnosis.
Definition
Folate
Term
Women with this deficiency who become pregnant are more likely to give birth to a low birth weight or premature infant, or an infant with neural tube defects.
Definition
Folate
Term
This vitamin is needed for the formation of collaged and the maintenance of connective tissue, bones, and teeth.
Definition
Vitamin C
Term
Deficiency of this vitamin, scurvy, is often due to dietary insufficiency and appears up to 1 year after the deficiency state starts
Definition
Vitamin C
Term
Name 3 deficiency manifestations of Vitamin C
Definition
1. Splinter hemorrhages, swollen, friable gums
2. Myalgias, and hemarthralgias
3. In more advanced conditions: tooth loss, secondary infections, gangrene, and spontaneous hemorrhages
Term
What does GERD stand for?
Definition
Gastroesophageal Reflux Disease
Term
Inflammation of the esophagus; due to reflux of acid gastric juice into the lower esophagus
Definition
GERD
Term
This results from malfunction of the lower esophageal sphincter and disordered gastric motility; may lead to peptic esophagitis, ulceration, stricture, or Barrett esophagus. Can be caused by bacteria, a virus, chemicals, dust, gas, or food/water aspiration.
Definition
GERD
Term
What are some clinical manifestations of GERD?
Definition
heartburn (chronic or recurrent epigastric or retrosternal pain), reflux, dysphagia, and painful swallowing
Term
What is the treatment for GERD?
Definition
Acid-suppressants, antacids, lifestyle modification, surgery
Term
What should a PT be aware of in a pt wit GERD?
Definition
-Exercise might make symptoms worse
-GERD is induced by strenuous exercise is common among athletes
-Intervention requiring a supine position should be scheduled before meals and avoided just after eating
-May need modify towards a more upright posture if symptoms persist during therapy
Term
Usually a squamous cell carcinoma
Definition
Esophageal cancer
Term
What are 2 major risk factors for esophageal cancer.
Definition
Heavy alcohol and tobacco use
Term
Most patients with this have metastases to the lymph nodes at the time of presentation, and local extension with invasion of nearby structures is also common.
Definition
Esophageal Cancer
Term
Occurs in 5-10% of cases and is usually related to Barrett's epithelium (columnar metaplasia of the lower esophagea lining)
Definition
Adenocarcinoma
Term
The intitial symptoms are dysphagia, leading to weight loss. Patients first experience difficulty swallowing solids, which gradually progresses to difficulty swallowing liquids as well. Weakness, anemia, pain, regurgitation, and aspiration are also noted. Coughing or hoarseness may be present if the laryngeal nerves involved.
Definition
Esophageal Cancer
Term
What are the treatments for esophageal cancer?
Definition
Surgery, radiation, chemotherapy. Prognosis is poor
Term
What should a PT be aware of with a pt with esophageal cancer?
Definition
Consider side effects of medications
Term
Inflammation of the gastric mucosa, can be acute or chronic.
Definition
Gastritis
Term
Etiology for this is varied and includes alcohol use, nonsteroidal anti-inflammatory drugs (NSAIDs), inflammatory bowel disease, viral infection or severe stress.
Definition
Gastritis
Term
__ gastritis involved superficial, rapidly developing lesions and occurs with severe stress, such as major trauma, burn, head injury, or hemorrhage.
Definition
Acute
Term
__ gastritis becomes increasingly common with advanced age
Definition
Chronic
Term
Mild dyspepsia is the presenting complaint. Blood in the nasogastric aspirate is the first sign in hospitalized patients.
Definition
Gastritis
Term
What are the treatments for Gastritis
Definition
H2-blockers, antacids, and avoidance of troublesome foods are the best treatment options for chronic disease.
Term
What should a PT be aware of for a patient with Gastritis
Definition
Monitor S&S of GI bleeding with elderly patients and patients on NSAIDs
Term
Ulcerative corrosion of the epithelium can occur anywhere in the esophagus, stomach, or duodenum.
Definition
Peptic Ulcer Disease
Term
H. pylori infection is the most important risk factor. It may be complicated by bleeding, perforation, or obstruction.
Definition
Peptic Ulcer Disease
Term
S&S may include burning or gnawing epigastric pain; may be alleviated by food or antacids; Nausea, vomiting, and epigastric tenderness is common.
Definition
Peptic Ulcer Disease
Term
What are the treatments for peptic ulcer disease?
Definition
Antibiotics for H. pylori infections, acid suppressants, and antacids
Term
What should a PT be aware of in a person with peptic ulcer disease.
Definition
-Monitor S&S of GI bleeding with elderly patients or patients on NSAIDs
-Perforated ulcr can cause back or right shoulder pain
Term
Ischemia of small or large bowel, caused either by intrinsic vascular disease or by extrinsic compression of intestinal blood vessels. Atherosclerosis is a common cause. Acute ischemia is caused by emboli occlusion.
Definition
Intestinal Ischemia
Term
Might result in a significant decrease in blood flow or occlusion of the visceral branches of abdominal aorta resulting inflammation and necrosis (infarct) of the intestine segment lacking blood supply
Definition
Intestinal Ischemia
Term
Might result in a rapid onset of abdominal pain or in chronic ischemia, abdominal cramping after eating; bloody diarrhea, a tender abdomen, and systemic symptoms
Definition
Intestinal Ischemia
Term
What should a PT be aware of in a patient with Intestinal Ischemia?
Definition
-Intestinal ischemia pain can results in intermittent back pain with exertion
-Clinical presentation combined with medical history, CAD risk factor, and PVD are the red flags; need for a medical referral if patient is not diagnosed.
Term
IBD (inflammatory bowel disease) may affect any part of the GI tract; refer to 2 diseases
Definition
Crohn's
Ulcerative Colitis
Term
Can occur in any age but 10-30 years is the most common. 20-25% might show up in family history. Occurs equally in both men and women. Cancer risk with this is increased so early detection is the best means of prevention.
Definition
Crohn's Disease
Term
Can occur with any age, but 10-40 years old is the most common. 20% of the time it will show up in family history. Occurs equally in men and women. Risk of cancer is increased but preventable with bowel resection.
Definition
Ulcerative Colitits
Term
Can occur in any segment of the body but small or large intestines are the most common. Skip lesions are common. The entire intestinal wall is involved and may be inflammed. Granulomas, thickened bowel wall, and a narrowed lumen and obstruction are all typical. Fissures and fistulas are also common.
Definition
Crohn's Disease
Term
Usually the lesions are located in the large intestin and rectum. Skip lesions are absent. Mucosal and submucosa layers may be inflammed. Granulomas, thickened bowel wall,a nd narrowed lumen and obstruction are all very uncommon. Fissures and fistulas are absent here.
Definition
Ulcerative Colitis
Term
Ab pain is common and can be mild to severe. Diarrhea may be absent to moderate. Bloody stools are unommon but abdominal masses are common in the right lower quadrant. Anorexia and weight loss can be severe.
Definition
Crohn's Disease
Term
Ab pain is less frequent but can be mild to severe. Diarrhea is typical and is often chronic and severe. Bloody stools are typical but abdominal masses are uncommon. Anorexia and weight loss is usually mild to moderate.
Definition
Ulcerative Colitis
Term
Skin rashes are common but mild. Joint pain is common but mild to moderate. Growth retardationis often marked. Pt can go thru remissions and exacerbations.
Definition
Crohn's Disease
Term
Skin rashes are common but mild. Joint pain is common but usually mild to moderate. Growth retardation is usually very mild. Pt can go thru remissions and exacerbations.
Definition
Ulcerative Colitis
Term
Experienced by abdominal pain, especially in the lower right quadrant; cramping, diarrhea, and pain at the anus is noted.
Definition
IBD
Term
What all should a PT be aware of in a pt with IBD?
Definition
-CD in terminal ileum may produce referred pain to the corresponding low back, lower right quadrant
-CD associated abscess or inflammation mass may cause hip, thigh, or knee pain, often with an antalgic gait (ambulation pattern characterized by a shortened stance phase on the affected side)
-25% IBD patients may present with joint problems as migratory arthralgias, monarthritis, polyarthritis, or sacroilitis
-IBD is associated with low bone mineral content and a high prevalence of osteoporosis
Term
A common disorder involving chronic GI complaints, often associated with psychiatric symptoms. Patients with this complain of chronic, crampy ab pain, bloating, flatulence, and diarrhea or constipation.
Definition
IBS
Term
A diagnosis of exclusion, and lactose intolerance must be ruled out. Presumptive diagnosis may be made in the context of chronic symptoms without weight change.
Definition
IBS
Term
What are the treatments for IBS?
Definition
Dietary bulk supplements, anticholinergics, and antidiarrheals are generally sufficient and tricyclic antidepressants may be helpful
Term
An acquired conition that refers to the presence of outpouchings in the wall of the colon or small intestine
Definition
Diverticulosis
Term
Contains feces but without infection
Definition
Diverticula
Term
Especiallycommon in developed nations due ot a low-fiber diet, resulting in increased intraluminal pressures
Definition
Diverticulosis
Term
Generally asymptomatic. Symptoms arise from a lower GI bleed or from diverticulitis.
Definition
Diverticulosis
Term
What is the treatment for diverticulosis?
Definition
It usually resolves spontaneously but a high-fiber diet is recommended
Term
A complication of diverticulosis, occurs when a diverticulum becomes infected or perforates, causing an abscess or peritonitis
Definition
Diverticulitis
Term
May be further complicated by formation of fistulas to the bladder, vagina, or skin or by the development of adhesions that cause small-bowel obstruction.
Definition
Diverticulitis
Term
Symptoms include acute ab pain, usually on the left side. Accompanied by fever, chills, altered bowel habit,and bloody stools. A lower abdominal mass may be present on the exam.
Definition
Diverticulitis
Term
Inflammation of the appendix
Definition
Appendicitis
Term
Occurs as the appendix becomes distended and a compromise of blood supply develops. Gangrene and perforation become increasingly likely
Definition
Appendicitis
Term
Vague periumilic ab pain with N&V are the first symptoms. Pain then localizes in the right lower quadrant. Pain over McBurney's point is typical. Temperature is only slighly elevated if no perforation has occurred. Fever and increased pain indicate possible performation.
Definition
Appendicitis
Term
Leukocytosis with more than 75% polymorphonuclear leukocytes ismost seen and treatment includes a surgical resection.
Definition
Appendicitis
Term
Small tissue masses projecting into the colonic lumen
Definition
Colonic Polyps
Term
Most of these are adenomas. These malignant adenomas are probably the origin of most large-bowel adenocarcinomas. Adenomatous polyps are found in 50% of 70 year olds.
Definition
Colonic Polyps
Term
A rare, autosomal dominant condition involving multiple polyps that eventually develop into colorectal cancer if untreated.
Definition
Familial Adenomatous Polyposis
Term
Are polyps generally symptomatic?
Definition
No
Term
Larger lesions can cause intermittent bleeding and changes in bowel habits, such as increased frequency, constipation, or tenesmus.
Definition
Colonic Polyps
Term
A painful spasm of the anal sphincter with an urgent desire to evacuate the bowel or bladder, involuntary straining, and the passage of little fecal matter or urine.
Definition
Colonic Polyps
Term
The 3rd most common site of cancer in Western countries
Definition
Colon
Term
The vast majority of colon cancers are __
Definition
Adenocarcinoma
Term
Genetic predisposition is known with familial adenomatous polyposis and with two other disorders: cancer family syndrome and hereditary site-specific colon cancer. All of these are autosomal dominant.
Definition
Colon Cancer
Term
Other predisposing conditions include ulcerative colitis, schistosomal colitis, history of radiation exposure, and colonic polyps. Increased incidence is seen in higher socioeconomic classes and is probably related to high fat, high calorie, low fiber, and low calcium diets
Definition
Colon Cancer
Term
Spread most frequenctly to regional lymph nodes. May also spread by direct extension, as seen with the common circumferential growth pattern of left colon lesions, and it can invade nearby structures.
Definition
Colon cancer
Term
__ __ commonly leads to metastases in the liver or lungs. "seeding" or transperitoneal metastasis, may cause local implants or generalized abdominal carcinomatosis.
Definition
Hematogenous spread
Term
Adenocarcinoma that remains asymptomatic for about 5 years
Definition
Colon Cancer
Term
__ sided colon lesion typically cause weakness secondary to anemia, dyspepsia, and right sided-discomfort or fullness.
Definition
Right
Term
__ sided colon cancer more often causes changes in bowel habits from occlusion of the lumen, with alternating constipation and increased frequency, blood-streaked stoo, and stook with decreased diameter.
Definition
Left
Term
Metastatic nodes, called __ nodes or __ nodes, may be palpated in the supraclavicular region.
Definition
Virchow's
Sentinel
Term
In 70% of patients, __ __ is elevated in the serum, but this finding is not specific to colon cancer. It is not considered an appropriate screening tool, but it can be useful to detect recurrences.
Definition
CEA (Carcinoembryonic Antigen)
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