faridi

Cards (73)

  • Esophageal Achalasia
    Motility disorder of the lower esophagus and LES (do not relax properly)
  • Esophageal Achalasia
    • Makes it difficult for food and liquid to pass from the esophagus into the stomach
    • normal: LES (smooth muscle) contracts under stimulation by vagal cholinergic inputs
    • normal: When swallow is initiated, vagal inhibitory fibers allow sphincter to relax
  • Cause of Esophageal Achalasia
    • Degeneration of the myenteric plexus
    • Loss of the inhibitory neurons that allow for relaxation of the LES
    • LES remains closed
    • Effective esophageal peristalsis is also often lost
  • Hiatal hernia
    Protrusion of the stomach above the diaphragmatic esophageal opening
  • Reflux esophagitis
    Caused by conditions that result in persistent or repetitive acid exposure to the esophageal mucosa
  • Recurrent reflux
    Results in a change in the esophageal epithelium from squamous to columnar histology → Barrett esophagus
  • 2-5% of cases with Barrett esophagus lead to the development of esophageal adenocarcinoma (cancer)
  • Peptic ulcer disease
    Characterized by discrete ulcerative lesions which may spontaneously heal or enlarge/rupture (with increased motility)
  • Approximately 95% of duodenal ulcers and 85% of gastric ulcers occurred in the presence of H. pylori infection
  • Not all individuals infected with H. pylori or taking NSAIDs develop PUD
  • H. pylori Infection
    • Bacteria protects itself by producing large amounts of urease
    • Hydrolyzes the urea (from protein metabolism) to ammonia
    • Ammonia neutralizes acid – good for bacteria but toxic to mammalian cells
    • Ammonia damages mucous layer and epithelial cells
    • HCL and enzymes leak in and cause further damage
  • SRMD (Stress-Related Mucosal Damage)
    • Cause: systemic response to stress – commonly seen in the ICU setting
    • May resolve upon treatment of primary disease, but requires aggressive treatment to prevent blood loss, mucosal damage, and reduce mortality
  • Gastritis
    Inflammation of the gastric mucosa
  • NSAID-induced gastric damage
    • NSAIDs cause breaks in gastric mucosal barrier
    • H+ ion leaks into mucosa → epithelial cell injury and death
    • Overwhelms mucosa ability to protect itself
    • Local capillaries are also damaged → bleeding
    • Inhibit activity of cyclo-oxygenase-enzyme important in synthesis of gastroprotective prostaglandins
  • Neoplasms of the Stomach
    • Gastric ulcer predisposition
    • Genetic factors - family predisposition
    • Dietary factors - dietary carcinogens
    • Infectious disease factors - bacterial and viral
  • Motility Disorder and the Small Intestine
    • Transit time – normally 40-180 min
    • Uncoordinated contractions, obstruction, or herniation have serious consequences: N/V, Cramping or sharp pain, Peritonitis, Fever and sepsis
  • Lactose intolerance
    • Lactose is not broken down and stays in the lumen
    • Diagnosis: lactose challenge - stop consuming lactose then reintroduce to see if symptoms occur
    • Most common cause: lactase deficiency
  • Irritable Bowel Syndrome
    • IBS-C – Decreased GI motility and spasm (Constipation)
    • IBS-D – Increased GI motility and spasm (Diarrhea)
    • Associated with changes in dietary, emotional, or environmental status
  • Bowel Infarction – Intestinal Ischemia
    • Irreversible injury to the intestine resulting from insufficient blood flow
    • May result from atherosclerosis or embolism
    • Gray appearance upon visual exam
    • Mesenteric artery occlusion
  • Bowel Infarction – Intestinal Ischemia is rare: 1:200,000
  • Diverticulosis
    • Caused by low fiber diet
    • Small outpouchings of the colon
    • Common in sigmoid
    • Fecal impaction, seeds, and nuts may lodge into these spaces resulting in an acute inflammatory condition diverticulitis
  • Diverticulitis
    • Cause: inflammation or infection of one or more diverticula
    • Left sided pain (sigmoid)
    • Fever
    • Constipation
    • Feeling of fullness
    • Lack of appetite
  • Appendicitis
    Acute – inflammation, ulceration, and perforation of medical emergency
  • Repeated episodes of diverticulitis may lead to abscess, ulceration, scarring transmural adhesion and fistulas
  • Diverticulosis is caused by a low fiber diet
  • Diverticulosis
    • Small outpouchings of the colon
    • Common in sigmoid
  • Fecal impaction, seeds, and nuts may lodge into diverticula spaces resulting in an acute inflammatory condition diverticulitis
  • Diverticulitis is caused by inflammation or infection of one or more diverticula
  • Bowel incontinence is the inability to control bowel movements
  • Causes of bowel incontinence
    • Surgery
    • Hemorrhoids
    • Aging
    • Crohn's disease
    • Trauma
    • Diabetic neuropathy
    • AIDS
  • Hemorrhoids
    • Masses of swollen veins that may become inflamed, bleed, and can be extremely painful
    • Internal and external hemorrhoids
  • Hemorrhoids are associated with pregnancy, aging, heavy lifting, and changes in bowel habits
  • Adenomatous polyps

    • Painless, pre-malignant growths into the lumen of the colon
    • Most common in men/women > 40y/o
  • Screening by endoscopy for adenomatous polyps is important, especially for those over 50 years old
  • Adenomatous polyps are always removed, since they are premalignant lesions and ulceration may indicate malignant transformation
  • Screening tests for colorectal cancer
    • Fecal occult blood test
    • Sigmoidoscopy
    • Air contrast barium enema
    • Colonoscopy
  • Fecal occult blood test
    Exam for stool blood
  • Sigmoidoscopy
    • View lining of rectum and lower third of the colon
  • Air contrast barium enema

    • X-ray the entire colon and rectum
  • Colonoscopy
    • Rectum and inside of the entire colon is examined