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GI System

Clin Med II

fundus of stomach storage
antrum of stum mixing
function of the stomach converts food to chyme
accessory organs of the GI system teeth, tongue, salivary glands, liver, gallbladder, pancreas, & appendix
functions of mouth food enters, digestion begins, hydrolysis (salivary breakdown forms a bolus (food ball)) occurs, chewing, & swallowing
fxn of upper esophageal sphincter keeps air from entering tube
chyme semisolid mixture that moves on to SI
small intestine most fxn in duodenum & jejunum; ileum responsible for transport; first place nutrients are absorbed
large intestine term end of digestive tract; any undigested/unabsorbed food material enters the lg intestine; drying of feces as water & salts are absorbed & storage of feces; leftover material is acted upon by bact
4 basic digestive processes of the stomach motility, secretion, digestion, absorption
motility filling, storage, mixing, emptying
storage food is stored in the bod of the stomach; fundus contains only a pocket of gas; muscs in antrum are thicker & stronger in order to mix
factors that influence rate of gastric emptying strength of contraction, amount chyme in stomach, the presence of fat, acid, hypertonicity, or distension in the duodenum;
mucosal lining of the stomach protective barrier
3 phases of control of gastric secretion cephalic phase, gastric phase,& intestine phase
cephalic phase feedforward prod of HCL & pepsinogen by stimuli acting in the head even b4 food reaches stomach; incr in gastric secretion by vagal nerve; starts b4 food is even in mouth
gastric phase food reaches stomach: protein in stomach stims release of gastrin==> HCL & pepsinogen secretion
Intestine phase inhibitory phase: shuts off the flow of gastric juices as chyme begins to empty into small intestine
role of HCL activates the enzyme precursor pepsinogen to an active enzyme pepsin; provides an optimum environment for pepsin act (acidic); denatures protein; kills most of micro-organisms ingested with food
two non-nutrient substances absorbed in stomach aspirin & alcohol
segmentation mixes & propels chyme via pacesetter cells in the sm intestine; ringl9ike contractions initiate peristalsis
migrating mobility complex int house=keeper; pushes out any remaining food
achalasia failure to relax the smooth musc of the GI tract, especially in the lower esophageal sphincter
factors that decrease LES Pressure foods, caffeine, alcohol, CNS depressant meds, systemic scleroderma
factors that increase gastric pressure high-protein food, obesity, tight clothes
types of gastritis acute gastritis (hemorrhagic or erosive, associated w/ serious illness & various meds (NSAIDS))); chronic gastritis (asymptomatic)
chronic gastritis Type A: chronic fundal gastritis (less common, pernicious anemia, occurs w/ autoimmune dz's); Type B: more cmn, chronic bact infection, H. pylori
acute gastritis epigastric pain, abd distension, loss of appetite, v/n, low grade fever,
dx of gastritis confirm presence of H. pylori by urea breath or stool antigen test
pyloric stenosis projectile vomiting at birth; firm, palpable nodule in RUQ
gastric adenocarcinoma attributed to H. pylori bact; contributes to 90% of stomach tumors; common location: lesser curvature of prepyloric antrum; asymptomatic early on; postop chemo ineffective; palpation of L supraclavicular lymph node
peptic ulcer a break in the protective mucosal lining exposing submucosal areas to gastric secretions; damage to musculature, resulting in scar tissue; 3 types: gastric ulcers, duodenal ulcers, & stress ulcers; usu due to H. pylori & excessive prod of acid
gastric ulcer lining of stomach; usu at lesser curvature on post wall
duodenal ulcer usu in duodenal bulb or cap (closest portion of duodenum to the stomach)
stress ulcer painless until perforation or hemorrhage; upset to aggressive-defense balance (sympathetic response) & ischemia to gastric mucosa
classic symptoms of peptic ulcers epigastric pain described as a burn, cramp, or ache near the xiphoid process
antisecretory drugs decrease acidic secretions
vital signs signaling bleeding SBP under 100 mmHg, pulse rate >100 bpm, & drop of 10 mmHg or more in DBP
upper GI consists of mouth, esophagus, stomach, & small intestine
esophagus food formed into a bolus
lower GI cecum to anus (includes appendix)
fistulae abnormal connections between organs
preparation for lower GI tests dietary changes (low fiber diet 2-3 days b4), no smoking, no meds, laxatives, & inform MD if insulin pump
fecal occult blood test detects presence of microscopic or invisible blood in feces; blood in stool may be only symptom of early colorectal CA; to determine cause of anemia; usually want to take multiple tests: 3 diff tests on 3 diff days for intermittent bleeding
melena black, tar-like BM, indicating CA
stool culture can detect presence of dz-causing bact or infection of digestive tract
Imaging studies injury or trauma in pelvic area, difficult w/ urinating/defecating, CA in pelvic & abdominal organs, infertility, an undescended testicle
barium enema examines rectum, lg intestine, & the lower part of the small intestine; metallic compound outlines stomach, intestines, etc...
defecography evaluates completeness of stool elim, id's anorectal abnormalities, & evals rectal musc contractions & relaxation;
colorectal transit study aka Sitzmark's test; x-ray imaging test that shows how well food moves through the colon; through swallowing capsules containing x-ray markers
laparoscopy used to directly visualize abdominal & pelvic organs when a pathological condition is expected; colectomy & appendectomy improve;
irritable bowel syndrome (IBS) most cmn disorder of the GI system; a group of symptoms; no inflammation; affects colon & SI; a fxn'l disorder, not due to structural or biological probs; altered GI motility, visc hypersensitivity, altered processing of info by nervous system
IBS Cont... abnormal intestinal contractions due to stress & chems in food; 3 mos of abdominal pain & at least 3 of the following sxs: bloating, passage of mucus, changes in stool form, stool freq alterations, difficulty passing bowel; LLQ pain
inflammatory bowel dz (IBD) Crohn's Dz & Ulcerative Colitis; body's inability to detect self-antigens from foreign antigens; inappropriate immune response;
Crohn's Disease can affect all wall layers, but w/ normal layers in between; accumulation of intestinal content breaches mucosal barrier resulting in chronic inflammation; narrows intestinal lumen; incurable
ulcerative colitis no normal layers btwn damaged layers; damages mucosa & submucosal chronic diarrhea, rectal bleeding w/ ulcerations, lg intestine primarily affected; abscess formation, necrosis; cured by colon resection
PT considerations for CD & UC back pain, RLQ pain, psoas abscess can cause pain & antalgic gait, joint involvement due to TNF (CD), anytime pt has low back, hip, pelvic, or SI pain for no reason,
colorectal cancer increased risk in men 40+; high mortality rate b/c no early screening tests; Risk factors: sedentary lifestyle, diet, obesity, UC, CD, other cancers, adenometous polyps; asymptomatic until metastasis; incr'd physical activity helps prevention
carcinoembryonic antigen (CEA) tumor marker for GI CA's, esp in advanced & recurrent CA's
Diverticular Dz diverticulosis (stage 1) & diverticulitis (stage 2); risk factors: low fiber diet, chronic constipation, weakness or atrophy of bowel muscle,
diverticulosis herniation of mucosa & submucosa through muscular layers (diverticula); bld supply decr'd; common, everyday, asymptomatic phase; incr'd urgency to defecate
diverticulitis inflammation of diverticula due to entrapment of food & feces; most common in sigmoid colon; rarely reversible; constipation & diarrhea, fever, rectal bleeding, anemia, & if chronic, obstruction & bowel perferation
malabsorption diseases celiac dz, CF, CD, pancreatic carcinoma, pernicious anemia (B12), short gut syndrome
malabsorption diseases celiac dz, CF, CD, pancreatic carcinoma, pernicious anemia (B12), short gut syndrome; early sxs: depression, abd bloating, prod of bulky, malodorous oil stools; flatulance; late sxs: low bp, infertility
appendicitis inflammation results in necrosis & perforation; peak incidence in men; acute pelvic pain in fm's;
Created by: MeganFultz2



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