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fund of Disease ch9

Diseases of the Gastrointestinal System Chapter 9

Oral neoplasms(new growth) commonly occur on the 1.Floor of the oral cavity(mouth) 2.Tongue 3.Interior oral labia(lip)
Labial carcinoma is often associated with pipe and cigar smoking
Carcinomas of the buccae(cheeks), tongue, or palate(oral roof) are commonly associated with chewing tobacco or dipping(snuff)
A premalignant sign of an oral neoplasm(new growth) is leukoplakia (white patches that appear on the mucous membranes of the oral cavity
Dx of an oral neoplasm(new growth) is confirmed with a Bx(biopsy)
Oral neoplasms(new growth) respond well to surgery & radiation therapy
Signs & symptoms of an esophageal malignancy include 1.Dysphagia(difficult swallowing) 2.Vomiting 3.Halitosis(bad breath) 4.WT(weight) loss 5.Aphagia(inability to swallow)
Dx for an esophageal malignancy includes an UGI(Upper GastroIntestinal) AKA barium swallow
The Px(prognosis) for an esophageal malignancy is poor because metastasis(spread) usually occurs before detection
Esophagitis is an inflammation of the esophagus
Esophagitis is commonly caused by GERD(GastroEsophageal Reflux Disease)
GERD(GastroEsophageal Reflux Disease) is commonly caused by an incompetent cardiac sphincter(lower esophageal sphincter)
The incompetent cardiac sphincter(lower esophageal sphinclter) allows stomach contents to regurgitate(reflux/back flow) up the esophagus
Signs & Symptoms of GERD(GastroEsophageal Reflux Disease) include 1.Dyspepsia(indigestion) 2.Eructation(belching) 3.Dysphagia(difficult swallowing) 4.Halitosis(bad breath) 5.Hematemesis(vomiting blood) 6.Thoracodynia(chest pain)
The signs & Symptoms of GERD(GastroEsophageal Reflux Disease) may be exacerbated(make worse) by 1.Eating 2.Drinking 3.Bending over 4.Lying Down
GERD(GastroEsophageal Reflux Disease) is more common with obesity & pregnancy
Dx of GERD can be confirmed with an EGD(EsophagoGastro Duodenoscopy)
Tx (treatment) for GERD includes 1.Nonirritating diet(bland) 2.Antacids(mylanta) 3.Antiulcer drugs(Pepcid)
A HH (Hiatal Hernia) is a protrusion of the stomach through the diaphragm(primary muscle of ventilation)
A HH (Hiatal Hernia) is AKA a diaphragmatic hernia
Signs & symptoms of a HH (Hiatal Hernia) include 1.Dyspepsia (indigestion) 2.Postprandial dyspepsia(indigestion after meals) 3.SOB (shortness of breath)
A HH (Hiatal Hernia) may cause the cardiac sphincter(lower esophageal sphincter) to become incompetent causing GERD(GastroEsophageal Reflux Disease)
Dx for a hiatal hernia(HH) is confirmed with a CXR(Chest X-ray) & UGI (Upper GastroIntestinal) AKA barium swallow
Tx for hiatal hernia(HH) include 1.Avoidance of spicy foods, ETOH(alcohol), & caffeine 2.WT(weight) loss for obese patients 3.Abdominal supports 4.Hernioplasty(surgical repair of the hernia
Gastritis is an inflammation of the stomach frequently accompanied by hematemesis(vomiting blood)
Gastritis can be caused by irritants such as 1.*NSAIDs(non-steriodal Anti-Inflammatory Drugs) such as ASA(Aspirin),Motrin(ibuprofen) & Aleve(naproxen) 2.Caffeine 3.Tobacco 4.Spicy foods 5.Alcohol(ETOH) 6.Infection
Dx of gastritis is confirmed with a gastroscopy(viewing the stomach with a lighted instrument) and Bx(biopsy)
Signs & Symptoms of gastritis include 1.LUQ (left upper quadrant) abdominal pain 2.Hematemesis(vomiting blood)
Tx for gastritis includes 1.Removal of irritants 2.Antacids(Maalox, Tums, Rolaids) 3.Antiulcer drugs(Pepcid, Zantac)
PUD (Peptic Ulcer Disease) is an ulcer(erosion/worn away) of the stomach and/or duodenum(1st section of the small intestine)
The primary symptom of PUD(Peptic Ulcer Disease) is abdominal pain
PUD (Peptic Ulcer Disease) abdominal pain is relieved temporarily by antacids(Maalox, Tums) and food
Causes of PUD(Peptic Ulcer Disease) include 1.Poorly controlled stress 2.Excessive production of HCl(HydroChloric Acid) 3.NSAIDs(Non-Sterodial Anti-Inflammatory Drugs) such as ASA(aspirin),Advil(ibuprofen) and Naprosyn(naproxen) 4.H.(Helicobacter) pylori(bacteria)
Tx of PUD(Peptic Ulcer Disease) includes 1.Stress management(regular exercise) 2.Reduction of irritants 3.Antiulcer drugs(Nexium,Zantac,Pepcid) 4.Antacids(Tums,Gaviscon,Maalox) 5.Antibiotic therapy(amoxicillin) **PUD is not treated by drinking milk**
A complication associated with PUD (Peptic Ulcer Disease) is ulcer perforation(rip or tear) and hemorrhage (rapid flow of blood)
Signs of perforation include 1.Extreme abdominal pain 2.Hematemesis(vomiting blood) 3.Melena(black, tarry, pungent/aromatic stools)
A complication of ulcer perforation is peritonitis(inflammation of the abdominal lining)
Ulcer perforation requires surgery
Dx of PUD(Peptic Ulcer Disease) can be confirmed with a barium swallow(Upper GastroIntestinal) UGI
Gastroenteritis is an inflammation of the stomach and small intestine(bowel)
Causes of gastroenteritis include 1. Bacterial infections such as E.Coli(escherichia), salmonella & Listeria 2.Chemical toxins(poisons) 3.Lactose(Milk sugar) intolerance 4.Other food allergies
Signs & symptoms of gastroenteritis include 1.Colicky(spasm-like) dysentery(painful small bowel) 2.N&V(nausae & vomiting) 3.Pyrexia(fever) 4.Diarrhea(soft watery stool)
Dx of gastgroenteritis is confirmed with a stool CX(culture)
Tx of gastroenteritis include 1.IV(IntraVenous) hydration 2.Antibiotics(Cipro) 3.Antiemetics(phenergan/anti-vomiting) 4.Antidiarrheals(Imodium) 5.GI antispasmodics(Bentyl)
Salmonellosis is food poisoning caused by an enterobacteria called salmonella
Salmonellosis can cause gastroenteritis 6 to 48 hours after ingestion of tainted food
Dx of salmonellosis can be confirmed by a stool CX(Culture)
Symptoms of salmonellosis can last up to 2 weeks
The primary complication of salmonellosis is dehydration(hypovolemic shock)
Prevention of salmonellosis include 1.Proper refrigeration of foods 2.Thorough cooling of foods 3.Prevent cross contamination of food 4.Proper frequent hand washing
Gastric malignancies are more common in men(2 to 1) over age 55
Signs and symptoms of gastric malignancy include 1.Anorexia(loss of appetite) 2.Dyspepsia(indigestion) 3.N&V(nausea & vomiting) 4.PA(Pernicious Anemia) caused by vitamin B/12 deficiency 5.Achlorhydria(no hydrochloric acid(HCl) in the stomach
Dx of a gastric malignancy is confirmed with a gastroscopy(viewing the stomach with a lighted instrument) and Bx(biopsy)
Risk of gastric malignancies increases with H.(Helicobacter) pylori infection of the stomach >The consumption of dried,smoked,salted,or preserved foods(especially meats), and a diet dificient in fresh fruits and vegetables >Chronic gastritis(inflammed stomach)>Family history of gastric malignancy
Tx for a gastric malignancy includes 1.Chemotherapy(antineoplastics) 2.Radiation therapy 3.Surgery
Px(prognosis) for a gastric malignancy is good if detected before metastasis(spread) Only 1 in 5 survive 5 years after metastasis
Appendicitis is an inflammation of the appendix
Signs & Symptoms of the appendicitis include 1.N&V(Nausea & vomiting 2.Pyrexia(fever) 3.Leukocytosis(elevated WBCs) 4.Right inguinal(Iliac) rebound tenderness
Tx for appendicitis is an appendectomy(surgical/excision removal of the appendix
Complications of appendicitis include 1.Gangrene(putrification(rot) 2.Appendorrhexis(rupture of the appendix) 3.Peritonitis(inflammation of the abdominal lining)
Malabsorption syndrome is the inability to absorb fat from the small intestine(small bowel)
The inability to absorb fat causes the stool(feces) to become 1.Unformed(loose) 2.Fatty 3.Pale 4.Pungent(aromatic) 5.Floaters
A complication of malabsorption syndrome is the inability to absorb the fat soluble vitamins A,D,E & K
Vitamin K deficiency can cause bleeding tendencies
Tx for malabsorption syndrome includes injectable vitamin A,D,E & K supplements
Diverticulitis is an inflammation of diverticula(blister like pouches or sacs that develop in the large intestine(large bowel/colon)
The primary symptom of diverticulitis is LLQ(Left Lower Quadrant) cramp-like abdominal pain
A complication of diverticulitis is bowel obstruction(ileus) and abcesses (collections of pus)
Dx of diverticulosis is confirmed with a BE(Barium Enema) AKA lower GI
Tx for diverticulitis includes 1.Antibiotics(Augmentin) 2.Increase fiber in diet(whole grains, leafy green vegetables/fruits) 3.Decrease intake of gas forming foods(legunes/beans & peas) & cabbage
CD(Crohn's Disease) is AKA RE(regional enteritis)
CD(Crohn's Disease) is a chronic, idiopathic(unknown autoimmune/attacking itself) IBD (inflammatory bowel disease)
CD (Crohn's Disease) runs in families
CD(Crohn's Disease) is usually diagnosed between the ages of 20 and 40
CD(Crohn's Disease) may be exacerbated(made worse) by poorly controlled stress
Signs & symptoms of CD(Crohn's Disease) include 1.Appendicitis-like pain 2.Alternating bloody diarrhea(loose watery stool) and constipation(difficult defecation) 3.Melena(black, tarry, pungent/aromatic stool) 4.Anorexia(loss of appetite) 5.N&V(Nausea & Vomiting) 6.WT(weight) loss
Dx of CD(Crohn's Disease) is confirmed with a colonoscopy(viewing the colon with a lighted instrument) and Bx(biopsy)
Periods of exacerbation and remission are common with some cases ending in perforation(tear or rip) or lieus(bowel obstruction)
Tx of CD(Crohn's Disease) includes 1.Immunosuppressant medications(Imuran & Humira) 2.SAIDs(steroidal anti-inflammatory drugs) (prednisone) 3.Antibiotics(Ampicillin) 4.Avoiding trigger foods
Chronic Ulcerative Colitis(UC) is an idiopathic(unknown possible autoimmune) IBD (Inflammatory Bowel Disease) usually afffecting the colon and rectum
Chronic UC(Ulcerative Colitis) increases the risk of colon malignancies
UC (Ulcerative Colitis) may be exacerbated (made worse) by poorly controlled stress
UC(Ulcerative Colitis) runs in families (10-30%)
UC (Ulcerative Colitis) usually occurs in young adults, especially women, and usually begins between ages 15 and 20
Signs & symptoms of UC(ulcerative colitis) include 1.Sudden diarrhea with pus and blood 2.Cramplike pain in the lower abdomen 3.Anemia(erythrocytopenia and/or deficiency of hemoglobin)from chronic blood loss
Dx of UC(ulcerative colitis) is confirmed with a colonoscopy (viewing the colon with a lighted instrument) and BaE(Barium enema(BE)
Tx for UC(ulcerative colitis) includes Lialda(mesalamine)*Stress management*Diet modification(no caffeine, raw veggies, legumes/beans& peas, whole grains,nuts,seeds)*Mild sedation(librium)*Corticosteroids(hydrocortisone)*Psychological counseling*Colostomy(artifical opening into the colon)
Carcinoma of the Colon & Rectum (malignancies) are found in the rectum & sigmoid colon
Dx of carcinoma of the colon & rectum is made with 1.DRE(Digital(finger) Rectal Exam) 2.Sigmoidoscopy or colonoscopy(viewing of the sigmoid colon or entire colon w/ a lighted instrument) 3.Bx(biopsy)
Colorectal malignancies detected early respond well to surgical treatment
Early signs & symptoms of carcinoma of the colon and rectum include 1.change in bowel habits 2.abdominal discomfort 3.occult(hidden) blood in stools or melena(black, tarry pungent/aromatic stool) 4.Anemia(erythrocytopenia and/or deficiency of hemoglobin)
Early detection of colorectal malignancies can occur with 1.Regular physical examinations 2.Regular stool guaiac(Hemoccult) tests
Risk factors for colorectal malignancies include 1.long-standing UC(Ulcerative Colitis) 2.Polyps(premalignant lesions of the colon) 3.A diet rich in red meat and fat and low in fiber 4.Deficient Ca(Calcium) in diet (less than 700mg/day)
Each year _______ Americans die from colorectal malignancies 72,000
Deaths from colorectal malignancies can be decreased by 90% if Colonoscopies are routinely performed after age 50 or if there is a previous hx(history)of polyps
ACS (American Cancer Society) suggests the following at age 50 -Colonoscopy every 10 years -Sigmoidoscopy every 5 years -BaE(Barium Enema) every 5 years -Virtual colonoscopy every 5 years -If no access to these test, stool guaiac(Hemoccult) every year
A bowel obstruction is AKA ileus
An ileus caused by a reduction of peristaltic (bowel contraction) activity is called a paralytic ileus (stool blockage)
An ileus (bowel obstruction) caused by the bowel twisting on itself is called a volvulus (garden hose kinks)
An ileus caused when the intestine telescopes on itself is called intussusception (telescoped inside itself)
An ileus can also be caused by adhesions (tissue sticking together)
Signs & Symptoms of an ileus (bowel obstruction) include 1. Severe abdominal pain 2. Distended(stretched out) abdomen 3. Vomiting & constipation(difficult defecation)
Dx(diagnosis) of an ileus(bowel obstruction) is confirmed with an abdominal CT (computerized tomography)
Tx (treatment) for an ileus(bowel obstruction) usually involves laparoscopic(lighted instrument to view the abdomen) bowel resection(surgical removal of bowel)
IBS stands for Irritable Bowel Syndrome
IBS usually affects women between their late teens & early 40s
Signs & symptoms of IBS(Irritable Bowel Syndrome) include 1.Sudden diarrhea 2.Constipation 3.Abdominal paid 4.Flatulence (flatus) {gas expelled through the anus)
Symptoms of IBS(Irritable Bowel Syndrome) tend to worsen with poorly controlled stress
The difference between IBS(Irritable Bowel Syndrome) and other intestinal disorder is that no lesions are present on examination
IBS(Irritable Bowel Syndrome) is a disorder of motility(peristalsis) and intestinal wall muscle spasms(Adult colick)
Tx for IBS (Irritable Bowel Syndrome) includes >Increasing fiber in diet >Avoiding caffeine, fatty food, spicy foods, alcohol(ETOH), citrus, cabbage,lagumes(beans, peas) >Stress management >GI antipasmodies(Bentyl) >Antidiarrheals(Kaopectate) >Sedatives(Xanax)
Cirrhosis is a chronic degeneration (deterioration) of the liver
Cirrhosis can be caused by 1)Alcohol(ETOH) 2)HBV(Hepatitis B Virus) or HCV(Hepatitis C Virus) 3)Drugs such as Tylenol(acetaminophen), Motrin(ibuprofen) & antihyperlipidemics(lipitor)
Dx of cirrhosis is confirmed with a liver Bx(Biopsy)
Signs & Symptoms of advanced cirrhosis include Tremors(shakiness) >Somnolence(alot of sleep) >Mental confusion >Gynecomastia(male breasts) >Lose chest hair >Testicular atrophy(sm) >Splenomegaly >Hepatomegaly(Lg liver) >Dialated abdominal veins >Tendency 2 hemorrhage >Pedal(ankel/feet) edema
More signs & symptoms of advanced cirrhosis include >Esophageal varices(vericose veins) >Jaundice >Ascites(accumulation of fluid in the abdomen) >Hepatic coma(unconscious with no response to stimuli)
Dx of cirrhosis is confirmed with LFTs(Liver Function Test) & liver Bx(Biopsy)
LFTs (Liver Function Test) include 1.SGOT(AST) 2.SGPT(ALT) 3.Alkaline phosphatase(Alk.Phos. or ALP) 4.LDH(LD) 5.Bilirubin
Viral hepatitis is an inflammation of the liver caused by a family of viruses called hepatitis A,B,C,D & E
The HAV(hepatitis A Virus) is the least serious & is usually transmitted in feces(stool)
Signs & Symptoms of the HAV(hepatitis A virus) can occur 2-7 weeks after exposure & usually lasts 2 months
Signs & symptoms of the HAV(hepatitis A virus) include >Fatique,Anorexia(loss of appetite), RUQ(right Upper Quadrant) abdominal pain, Cephalalgia(head pain), diarrhea, darkened urine(bilirubin in urine), Nausae, pale stools, myalgias(muscle pain), low grade pyrexia(fever), Jaundice
Px for the HAV(hepatitis A virus) is good with no permanent liver damage & a lasting immunity
A vaccine (Havrix, Vaqta) is now available for immunization(inoculation) against the HAV(hepatitis A virus)
HBV (hepatitis B virus) can lead to chronic hepatitis & cirrhosis
Signs & symptoms of the HBV(hepatitis B virus) are similar to the HAV(Hepatitis A virus)
Signs & symptoms of the HBV(hepatitis B virus) can occur 2 to 6 months after exposure
Transmissions of the HBV(hepatitis B Virus) is the same as the HIV(Human Immunodeficiency Virus)
The HIV & HBV are transmitted 1.Parenterally(needle/IV) 2.Sexually 3.Perinatally(during gestation/pregnancy, parturition/birth & breast feeding
Parenteral transmission usually refers to needle sticks & exposure to certain body fluids
Potentially hazardous body fluids include >blood or anything with blood in it >Synovial(joint) fluid >Pleural(lung) fluid >CSF(CerebroSpinal Fluid) during a LP(Lumbar Puncture) >Peritoneal(abdominal) fluid >Amniotic fluid(water breaks) >Breast milk
Carriers of the HBV(hepatitis B Virus) can be asymptomatic(no symptoms)
Damage from the HBV can cause fulminating hepatitis where the patient can suddenly become comatose & die
A lasting immunity can be achieved for the HBV (hepatitis B Virus) by vaccination(Hepatovax, Engerix B, Recombivax HB) or contracting the disease and recovering completely
Some people will not completely recover from the HBV(hepatitis B virus) and will be carriers of the disease
Tx for the HBV(hepatitis B virus) includes antiviral therapy
Signs & symptoms of the HCV(Hepatitis C Virus) are similar to the HBV(hepatitis B virus)
The HCV(hepatitis C virus) is insidious(slow to develop)(most dangerous)
The incubation period for HCV(hepatitis C virus) may take up to 20-30 years to damage the liver significantly
70% of people with the HCV(hepatitis C virus) are asymptomatic(no symptoms)
80% of people with the HCV(hepatitis C virus) will develop cirrhosis(degeneration of the liver) and/or liver cancer
The HCV(hepatitis C virus) is the #1 reason for a person to need a liver transplant
The HCV(hepatitis C virus) is transmitted 1.Parenterally(needle sticks & certain body fluids) 2.Sexually 3.Perinatally(during gestation/pregnancy, parturition/birth) (NOT FOUND IN BREAST MILK)
Everyone should be tested for the HCV(hepatitis C virus) who received a blood transfusion before July 1992
Tx for the HCV(hepatitis C virus) includes 1.Antiviral therapy 2.Liver transplant
Hepatic(liver) malignancies(cancer) are usually secondary tumors that metastasize(spread) from the colon, rectum, stomach, pancreas, esophagus, lung and breast
Hepatocarcinoma is a primary malignancy commonly associated with alcohol(ETOH), HBV(hepatitis B virus) and HCV(hepatitis C virus)
Signs & Symptoms of a liver malignancy include WT(weight) loss, RUQ(Right Upper Quadrant) abdominal mass and pain
Dx of a liver malignancy is confirmed with an AFP(AlphaFeta-Protein) blood test and liver Bx(biopsy)
The Px for a liver malignancy is poor
Cholecystitis is an inflammation of the gall bladder
Cholecystitis is commonly caused by an obstruction due to cholelithiasis(gall stones) AKA biliary calculi(stones in the bile duct)
The biliary obstruction can lead to hepatic(liver) damage
Increased incidence of cholelithiasis includes 1.Postpartum(after birth) women 2.Use of BCPs(Birth Control Pills) 3.DM(diabetes mellitus) 4.Cirrhosis(chronic degeneration of the liver) 5.Pancreatitis(inflammation of the pancreas)
Signs & symptoms of cholelithiasis(biliary calculi/bile duct stones) include 1.right rib cage pain radiating to the right shoulder, especially after eating a meal rich in fat 2.Chills 3.Pyrexia(fever) 4.N&V(Nausea & vomiting) 5.Jaundice(yellowing of skin and/or sclerae
Dx of cholelithiasis is confirmed with 1.GB(Gall Bladder) ultrasound 2.Hepatobiliary scan(HIDA) 3.ERCP(Endoscopic Retrograde CholangioPancreatography) 4.EUS(Endoscopic Ultra Sound) 5.MRC(Magnetic Resonance Cholangiogram)
Tx for cholelithiasis includes 1.Laparoscopic cholecystectomy(excision of the gall bladder) before preforation(rip/tear) occurs 2.Laparoscopic cholelithectomy(excision of gall stones) if stones are present in the common bile duct
Pancreatitis is an inflammation of the pancreas
Pancreatitis is commonly associated with alcoholism in men and GB(gall bladder) disease in women
Pancreatitis can cause pancreatic enzymes to activate prematurely(enzymes activate while still in the pancreas)
These activated pancreatic enzymes will start to digest(dissolve) the pancreas
Pancreatic enzymes include 1.Trypsin 2.Chymotrypsin 3.Lipase 4.Amylase
High levels of these pancreatic enzymes will confirm the diagnosis of pancreatitis especially the enzyme amylase
Signs & symptoms of pancreatitis include 1.Severe abdominal pain 2.N&V(nausea & vomiting) 3.Jaundice(yellowing of skin/sclerae)
Pancreatitis can result in death
Risk factors for a pancreatic malignancy include 1.male gender 2.smoking 3.high protein & high fat diets 4.alcohol(ETOH) 5.DM(diabetes mellitus)
Signs & symptoms of a pancreatic malignancy include 1.severe abdominal pain 2.anorexia(loss of appetite) 3.WT (weight) loss 4.Clay-colored stools(grey) 5.Jaundice(yellowing of skin/sclerae)
Dx of pancreatic malignancy is confirmed with a CT(Computerized Tomography) or MRI(Magnetic Resonance Imaging) or PET (Positron Emission Tomography and Bx(biopsy)
The Px(prognosis) for a pancreatic malignancy is very poor due to early metastasis(spreading)
Created by: Patti Belfi Reed Patti Belfi Reed