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Patho Ex3
| Term | Definition |
|---|---|
| Upper GI tract | Mouth, esophagus, and stomach |
| Middle portion GI tract | small intestine: duodenum, jejunum, ileum |
| Lower segment GI tract | cecum, colon (large intestine), and rectum |
| Accessory organs | salivary glands, liver, and pancrease |
| First layer of GI wall | mucosal |
| Second layer of GI wall | submucosal |
| Third layer of GI wall | muscularis externa |
| Fourth layer of GI wall | serosal |
| Mucosal layer of GI wall | produces mucus that lubricates and protects organs; secretes digestive enzymes and secretions to metabolize food; barrier to entry |
| Submucosal layer of GI wall | contains structures that secrete digestive enzymes |
| Muscularis externa layer of GI wall | facilitate movement of GI tract contents |
| Serosal layer of GI wall | contains structures that help control friction and placement of organs |
| Swallowing | relaxation of upper esophageal sphincter |
| What begins the digestive process by breaking down food to small pieces that can be swallowed? *(M___________) | Mastication |
| Swallowing reflex | starts voluntary then becomes involuntary when reaches pharynx |
| Name of process that moves food to the stomach | peristalsis |
| Term for partially digested food | chyme |
| Esophagus | consists of upper (voluntary muscle) and lower (involuntary muscle) |
| Upper esophageal sphincter | prevent air entry during respiration |
| Lower esophageal sphincter (cardiac sphincter) | prevents regurgitation of stomach contents |
| H. pylori | spiral shaped bacteria that burrows into GI lining |
| What do breaks in gastric mucosa cause? | inflammation and ulceration |
| How can use of NSAIDs cause breakdown of gastric mucosa? | they increase the permeability of stomach lining |
| intrinsic factor | necessary for B12 absorption |
| gastroferrin | necessary for iron absorption |
| All absorbed nutrients are processed in the.... | liver |
| What segment of small intestine sends signals to the stomach and causes a release of hormones? | the duodenum will secrete hormones if too much food is in the stomach |
| Peritoneum | serous membrane surrounding organs of abdomen and pelvis |
| Where does B12 absorption happen? | Ileum |
| Why are the villi of the small intestine important? | greatly increase surface area for absorption |
| Action of the large intestine | absorbs fluid and electrolytes |
| Defecation reflex is stimulated by... | movement of feces into sigmoid colon and rectum |
| dysphagia | difficulty swallowing |
| Rare form of dysphagia where esophagus does not propel | achlasia |
| Anorexia | lack of desire to eat, despite physiologic stimuli that would normally produce hunger |
| Nausea | subjective experience if feeling as if you are about to throw up |
| Vomiting | forceful emptying of the stomach and intestinal contents through the mouth |
| What are symptoms of vomiting? | hypersalivation and tachycardia |
| Retching | non-productive vomiting |
| Diarrhea | increased frequency and liquid consistency of bowel movements (>3BM/day) |
| Constipation | infrequent or difficult defecation ; straining w/ defecation (<3BM/week) |
| Abdominal X-Ray will diagnose... | air or gas in GI tract |
| Abdominal CT is taken to look at... | possible inflammation of the accessory organs |
| Barium swallow diagnostic test | uses x-rays and barium to give images of the upper GI tract |
| Endoscopy | a lighted telescope is put down esophagus to visualize upper GI tract |
| Colonoscopy | test to view the lower GI tract |
| Hiatal hernia | protrusion of part of the stomach through the diaphragm |
| Gastroesophageal Reflux Disease (GERD) | reflux of chyme and gastric/duodenal contents into esophagus |
| Inflammatory Bowel Disease - Gastritis | inflammatory disorder of gastric mucosa |
| What is most common cause of acute gastritis? | alcohol and NSAIDs |
| Peptic Ulcer Disease | break or ulceration in protective mucosal lining of lower esophagus, stomach, or duodenum |
| Types of PUD | Gastric ulcers and duodenal ulcers |
| Zollinger-Ellison Syndrome | neuroendocrine tumors secrete gastrin, which increases gastric acid |
| Where do gastric ulcers occur and what is their cause? | occur in the stomach and most often caused by use of NSAIDs |
| Duodenal ulcers | H. pylori infection in the duodenum causing more pain when the stomach is empty (night and between meals) |
| When will pain occur when one has a gastric ulcer? | right after eating |
| What are some symptoms of gastric ulcers that are less common in duodenal ulcers? | heart burn and chest pain |
| What kind of emesis will a gastric ulcer most likely produce? | bright red emesis |
| What kind of emesis will a duodenal ulcer most likely produce? | dark brown emesis |
| Gastrointestinal bleeding | bleeding hemorrhage inside the GI tract d/t weakened lining of digestive tract and increased permeability to hydrogen ions |
| What can cause a GI bleed? | peptic ulcers, diverticular disease, IBS, and ulcerative colitis |
| What can cause GERD? | weak esophageal sphincter, hiatal hernia, alcohol/smoking |
| If gastritis becomes chronic what can occur? | PUD or increased risk of developing stomach cancer |
| Intestinal obstruction | any condition preventing the flow of chyme through the intestinal lumen |
| Intestinal obstruction - Hernia | organ pushes through opening in muscle or tissue |
| Intestinal obstruction - Intussusception | part of the intestine slides into another part (slip n' slide!) |
| Intestinal obstruction - Volvulus | intestine twists around itself |
| Intestinal obstruction - Adhesions | scar tissue that forms between tissues and organs |
| Symptoms of intussusception | intense vomiting or failure to defecate |
| Hematemesis | bloody emesis |
| Hematochezia | bright red bloody stool |
| Melena | black, tarry stool |
| How might someone's stool look when they are taking iron? | black and tarry |
| Inflammatory Bowel Diseases - Ulcerative Colitis | chronic inflammatory disease causing continuous ulceration of colon mucosa |
| What surgery procedure can be done for ulcerative colitis? | colostomy placed and enflamed piece taken out |
| Inflammatory Bowel Diseases - Crohn's Disease | idiopathic inflammatory bowel disorder that can affect any part of the digestive tract from mouth to anus |
| "skipping lesions" | r/t Chron's disease - areas of inflammation followed by normal tissue |
| Inflammatory Bowel Diseases - Irritable bowel syndrome | chronic functional disorder with no specific structural or biochemical alterations as a cause |
| What s/s difference sets IBS apart from Chron's? | constipation and diarrhea will resolve after a few hours |
| Inflammatory Bowel Diseases - Diverticular Disease | diverticula; diverticulosis; diverticulitis |
| Diverticular Disease - diverticula | herniation of intestinal mucosa through muscle layers of colon (sigmoid) wall |
| Diverticular Disease - diverticulosis | asymptomatic diverticular disease (low fiber diet, weakened colon) |
| Diverticular Disease - diverticulitis | inflammatory stage of diverticulosis |
| What is the cause of Diverticular Disease? | low fiber diets |
| What can cause diverticulosis to become diverticulitis? | seeds and nuts |
| Where will pain appear for diverticulitis? | LLQ |
| Inflammatory Bowel Diseases - Appendicitis | inflammation of the appendix which prevents the outflow of mucus, allowing bacteria to multiply causing impaired blood flow to appendix |
| Where will pain occur for a patient with appendicitis? | RLQ |
| What occurs when the appendix bursts? | the bile contents release into the stomach |
| What can cause colorectal cancer? | high fat, low fiber diet; alcohol/smoking; obesity; age >50; inflammatory bowel disorders; Type II DM |
| Prolonged, chronic diarrhea is associated with... | malabsorption syndromes |
| Steatorrhea | stools bulky, yellow/gray, malodorous |
| glossitis (inflammation of tongue) can be caused by | folic acid deficiency |
| malnutrition | lack of nourishment from inadequate amounts of food |
| Long term starvation - Marasmus | protein and carbohydrate deficiency |
| Long term starvation - Kwashiorkor | condition caused by deficiency of dietary proteins, causing liver to swell because of inability to produce lipoproteins for cholesterol synthesis |
| What can protein deficiency in children cause? | decreased mental and cognitive development |
| Presence of fat in abdomen out of proportion to total body fat = | independent predictor of risk and mortality |
| What accessory organs of digestion will help digest chyme through secretion of certain enzymes, hormones, and bile (send to duodenum) | liver, gallbladder, and pancreas |
| Liver | highly vascular; metabolic functions require a large amount of blood |
| Functions of liver | produces bile, filters and detoxifies blood, removes ammonia from bodily fluids and converts it to urea, produces plasma proteins/vit A/amino acids, stores iron/vit K,D,D12/fats, converts glucose to glycogen |
| What are the 3 enzymes that help breakdown nutrients in pancreas? | protease, amylase, and lipase |
| Gallbladder | stores and concentrates bile by the liver |
| What is bile necessary for? | emulsification and absorption of fats |
| When is bile released and from where? | gallbladder releases it in response to presence of fatty acids and amino acids in duodenum within 30 min of eating |
| Bilirubin | produced from the breakdown of heme molecules after hemoglobin splits into heme and globin molecules |
| What produces the yellow tinge of jaundice? | bilirubin |
| Obstructive jaundice | r/t gallstones, inflammation, tumors of GB or pancreas |
| Hemolytic jaundice | r/t excessive hemolysis of RBCs, absorption of a hematoma |
| Cirrhosis | irreversible inflammatory disease disrupting liver function and structure |
| What can happen in cirrhosis that can lead to portal hypertension? | biliary channels become obstructed |
| Cirrhosis can be caused by... | alcohol, biliary, autoimmune disease, obstructive |
| Portal Hypertension | abnormally high blood pressure in the portal venous system caused by resistance to portal blood flow |
| Symptoms of portal hypertension | GI bleeding, abd ascites, hepatic encephalopathy |
| Complication of portal hypertension | varices (pouches of blood) in lower esophagus, stomach and rectum, causing GI bleeding |
| Abdominal ascites | buildup of fluid inside peritoneal cavity |
| Hepatic Encephalopathy | neurologic syndrome of impaired cognitive function, EEG changes, flapping tremor |
| Causes of hepatic encephalopathy | liver dysfunction and altered cerebral metabolism cause ammonia absorbed from GI tract to accumulate in body |
| How to treat hepatic encephalopathy | restrict protein intake; correct F&E imbalances; lactulose |
| Hepatitis A | transmitted by fecal-oral route, poor hygiene/sanitation |
| Hepatitis B | transmitted via blood; parenteral route; sexual contact |
| Hepatitis C | transmitted via blood; needle stick |
| Hepatitis E | transmitted by fecal-oral route; primarily seen in developing countries |
| Cholecystitis | inflammation of the liver |
| Cholelithasis | gallstone formation |
| Pancreatitis | inflammation of the pancreas d/t injury or damage to pancreatic cells and ducts, causing leakage of pancreatic enzymes into pancreatic tissue |
| What is a sign of pancreatic cancer? | pain in upper abdomen spreading to the back |
| Diurnal | hormones that vary with sleep-wake schedule (GH and ACTH) |
| Which hormones' secretion is based on a feedback mechanism? | insulin and ADH |
| A common cause of endocrine dysfunction is... | neoplasia, or tumor formation |
| Dysfunction of the anterior pituitary gland can cause complications of... | dwarfism, hypopituitarism, Cushing's, gigantism, and acromegaly |
| Dysfunction of the posterior pituitary can cause the complications... | Diabetes insipidus and SIADH |
| What Is the most serious hormone deficiency of the pituitary gland? | ACTH deficiency |
| What is the treatment for ACTH deficiency? | cortisol replacement, then identify underlying cause |
| GH deficiency | interferes with bone growth resulting in short stature or dwarfism |
| GH excess | results in increased linear bone growth - gigantism |
| Genetic short stature | have height close to mid-parental height of their parents |
| Psychosocial dwarfism | functional hypopituitarism that is seen in emotionally deprived children (GH returns to normal once taken out of environment) |
| Constitutional short stature | moderately short stature, thin build, delayed skeletal and sexual maturation |
| Acromegaly | GH excess in adulthood |
| What is the most common cause of acromegaly? | Somatotropic adenoma (excess secretion of GHRH by hypothalamic tumors; other non-endocrine tumors like small cell lung cancers) |
| Syndrome of Inappropriate Antidiuretic Hormone (SIADH) | hypersecretion of antidiuretic hormone |
| s/s of SIADH | low urine output (antidiuretic - prevent diuresis), hyponatremia (low sodium), mental status changes, decreased BUN, Cr |
| Diabetes Insipidus | disorder of water metabolism caused by deficiency of ADH |
| Neurogenic DI | lack of ADH caused by a severe head injury or tumor |
| Nephrogenic DI | insensitivity to ADH caused by renal tubules (hypokalemia, hypocalcemia, kidney ischemia) |
| s/s of Diabetes Insipidus | high urine output, hypernatremia |
| major functions of thyroid hormone | increase metabolism and protein synthesis ; influence growth and development in children (mental and sexual) |
| Thyroid hormone (TH) is secreted in response to | TSH |
| TH is made up of | T4 (converts to) and T3 (acts on target cell) |
| Hyperthyroidism | low TSH = high TH |
| s/s hyperthyroidism | increased HR, exophthalmos, low weight high appetite, sweating, insomnia/anxiety, high temp, diarrhea |
| thyrotoxicosis | increased levels of TH |
| Most common cause of hyperthyroidism | Graves' disease (auto-antibodies pretend to be TSH causing a reaction in the body) |
| Thyrotoxic crisis | hyperthermia, tachycardia, heart failure, agitation, N/V |
| Medication for hyperthyroidism that interferes with formation or release of TH | propylthiouracil (PTU) |
| Short term management of hyperthyroidism | iodine preparations |
| Hypothyroidism | high TSH = low TH |
| Autoimmune thyroiditis (most common) | Hashimoto's disease |
| Congenital hypothyroidism | no TH during fetal life leading to cognitive disability |
| Severe hypothyroidism - Myxedema coma s/s | hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis |
| Parathyroid glands | four glands on posterior side of thyroid that control calcium levels by production of parathyroid hormone |
| What vitamin is needed for PTH function? | Vitamin D |
| Hyperparathyroidism | elevated serum calcium - if levels > 13 mg/dL life threatening neuro, CV and kidney symptoms occur |
| Hypoparathyroidism | decreased serum calcium that can be shown through positive Chvostek's and Trousseau's signs |
| The release of glucocorticosteroids (cortisol) by the adrenal cortex are triggered by the | hypothalamus and pituitary gland |
| Mineralcorticosteroids (aldosterone) | function in sodium, potassium, and water balance |
| Glucocorticosteroids (cortisol) | aid in regulating the metabolic functions of the body and in controlling inflammation |
| Addisons's Disease | primary adrenal cortical insufficiency - ACTH levels are elevated d/t lack of feedback inhibition |
| Secondary adrenal cortical insufficiency | occurs as result of hypopituitarism or because pituitary gland has been surgically removed |
| Clinical findings of adrenal insufficiencies | anorexia and weight loss; GI upset; orthostatic hypotension; hyponatremia; hyperkalemia; hyper-pigmentation (increased ACTH = melanin release) |
| Cushing Syndrome | excessive production of ACTH by a tumor of the pituitary gland (pituitary form |
| Clinical findings adrenal cortical excess (Cushings) | altered fat metabolism (weight gain in face, trunk, and cervial area "buffalo hump"), hypokalemia, muscle weakness/wasting, vessels susceptible to rupture d/t protein wasting and loss of collagen |
| prolonged corticosteroid therapy can result in | adrenal insufficiency symptoms |
| Insulin | made by pancreas; found inside Islets of Langerhans - beta cells |
| Main function of insulin | allow body to utilize glucose from carbohydrates for energy or storage for future use; stops breakdown of protein and fat |
| Type I Diabetes | beta cells are destroyed d/t genetics and environmental factors; affects metabolism of fat, protein and carbohydrates |
| Manifestations of type I DM | hyperglycemia (can cause osmotic diuresis), 3 P's, weight loss |
| Type II Diabetes | initial insulin resistance with compensatory hyperinsulinemia, normally caused by age, obesity, sedentary lifestyle and family hx |
| Fasting blood glucose test | ≤100 = normal; ≥126 = diagnostic for DM |
| Random blood glucose test | ≥200 with symptoms (blurred vision, 3 Ps) = diagnostic for DM |
| Oral glucose tolerance test | ≥200 at 2 hr interval = diagnostic for DM |
| What will a urine test for DM show? | high level of ketones |
| Hypoglycemia | blood glucose level <70 with or without symptoms |
| Why are those with DM at risk for hypoglycemia? | Insulin treatment (dosage error) |
| Diabetic Ketoacidosis (DKA) | absence or inadequate amount of insulin resulting in abnormal metabolism of fat, proteins, and carbohydrates (seen in type I) |
| DKA - hyperglycemia leads to | osmotic diuresis, dehydration, and critical loss of electrolytes |
| DKA - ketosis, metabolic acidosis will show through | fruity breath, hypotension and tachycardia (volume depletion), CNS depression |
| With DKA, blood glucose levels will be | >300 to 1,000 |
| Ketoacidosis is reflected in | low ph and low serum bicarbonate |
| Why will a continuous IV of insulin be given to someone with DKA? | insulin enhances the movement of K+ from extracellular fluid into the cells |
| Hyeprglycemic Hyperosmolar Syndrome | blood glucose can rise to extremes above 600 mg/dL leading to osmotic diuresis |
| Somogyi effect | nocturnal hypoglycemia followed by rebound hyperglycemia (d/t hormones stimulates by hypoglycemia - gluconeogenesis) |
| Dawn phenomenon (At Dawn we Rise!) | early morning rise of blood glucose with no nighttime hypoglycemia (nocturnal elevation of GH) |
| Retinopathy (microvascular) | leading cause of blindness |
| Nephropathy (microvascular) | deterioration of kidney function (leading cause of end-stage renal disease) |
| Neuropathy (microvascular) | most commonly characterized by sensory deficits - loss of pain, temperature, vibration sensation |
| Types of macrovascular diseases most commonly seen in type II DM | CAD, stroke, PAD , ulcers and gangrene |
Created by:
Emurph31
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