Patho Exam 4
gastroesophageal reflux disease - ANS backward reflux of acidic gastric contents from stomach to the
esophagus
GER - ANS short term or intermittent do not cause issues
GERD - ANS weak/incompetent LES (lower esophageal sphincter) allows reflex to occur
GERD patho (progressive) - ANS repeated injury -- metaplasia -- squamous cells change to columnar
epithelium
NERD - ANS non-erosive reflux disorder
Barrett's Esophagus - ANS esophageal adenocarcinoma
GERD manifestations - ANS - AKA pyrosis
-retrosternal can radiate to throat, shoulder, back
-belching
-lying WORSENS symptoms
GERD diagnosis - ANS FIRST - before get invasive - try acid suppression medications
- endoscopy
-manometry
24-hour pH testing
GERD treatment - ANS -avoid stimulants (coffee/caffeine, chocolate)
-sit up after eating
-HOB increases (can use blocks or wedge booster)
squamous cell esophageal cancer - ANS linked to smoking and alcohol use
,adenocarcinoma esophageal cancer - ANS linked to GERD and Barrett's esophagus
manifestations of esophageal cancer - ANS - progressive dysphagia
- unintentional weight loss = anorexia
- pain
- fatigue
treatment of esophageal cancer - ANS - depends on tumor stage (poor prognosis)
gastric mucosal barriers - ANS protective mucosal barrier
- 2 main causes which are Aspirin and NSAID use, and infection
gastritis - ANS inflammation of gastric mucosal
peptic ulcer disease - ANS - ulcerative disorder in the upper GI tract that are exposed to acid-pepsin
secretions
(erosion in one or all layers of the stomach or duodenum)
most common peptic ulcer disease - ANS - duodenal (5x more common)
- gastric (average age middle and older adults)
causes of peptic ulcer disease - ANS H. pylori produces an enzyme that breaks down urea --- h.
pylori-bacterial infection
- NSAID inducer
(NSAIDS and Aspirin)
peptic ulcer disease manifestations - ANS - burning, gnawing, cramp-like
- pain in small area midline in epigastric near xyphoid
- stomach is empty
- pain CAN BE relived from food or antacids
,what screening to do with peptic ulcer disease? - ANS H. pylori screening
treatment for H.pylori - ANS - antibiotics - avoid NSAIDS and Aspirin, as well as, anticoagulants
- cauterize vessels and insert a balloon to dilate
stress ulcers - ANS - GI ulcers can develop in relation to major physiological stress
- Types are Curling's and Cushing
curling stress ulcer - ANS - gastric stress ulcer in severely ill patients
- burns, trauma, sepsis, ARDS
- ischemia to mucosa and alteration in gastric mucosa barrier
cushing stress ulcer - ANS - with intracranial injury (traumatic brain injury TBI) operation, tumors
causes: hyper secretion of gastric acid
stomach cancer etiology - ANS nitriso compounds benopyrene
manifestations of stomach cancer - ANS early: indigestion and burning
late: bloating after meals, and pain NVD/C
- Wt. loss, bleeding melena
stomach cancer DX and TX - ANS DX: barium xray
TX: gastrectomy
crohn's disease - ANS anywhere GI tract
ulcerative colitis - ANS colon and rectum
etiology of inflammatory bowel disease - ANS - unregulated and over-active immune response
against bacteria in the normal intestinal flora of susceptible individuals
- genetic predisposition
, - environmental trigger or infectious trigger
crohn's disease - ANS - granulomas type inflammatory response
- slowly progressive relentless
- onset of 20s and 30s
- sharply demarcated granulomatous lesions
- can lead to fibrosis and obstruction
crohn's disease manifestations - ANS - diarrhea, colicky pain, wt. loss
- occasional, but less bloody diarrhea compared to UC
- fluid and electrolyte disturbance
- malaise, low-grade fever
- absorption surface altered
complications of crohn's disease - ANS - increase risk of infection or abscesses
crohn's treatment - ANS - unable to cure, but goal = minimize discomfort and negative effects -
remission
ulcerative colitis - ANS - peak incidence 15-25 years
- confined to colon - usually begins in the rectum
- contiguous manner NOT skipping
- pinpoint mucosal hemorrhages develop into abscesses which can become necrotic and ulcerate,
bleeding common
- tongue like projections = pseudopolyps
etiology of ulcerative colitis - ANS - immune system dysfunction
- genetics
- changes in gut flora
- environmental triggers
DX of ulcerative colitis - ANS - sigmoid colonoscopy and Bx
gastroesophageal reflux disease - ANS backward reflux of acidic gastric contents from stomach to the
esophagus
GER - ANS short term or intermittent do not cause issues
GERD - ANS weak/incompetent LES (lower esophageal sphincter) allows reflex to occur
GERD patho (progressive) - ANS repeated injury -- metaplasia -- squamous cells change to columnar
epithelium
NERD - ANS non-erosive reflux disorder
Barrett's Esophagus - ANS esophageal adenocarcinoma
GERD manifestations - ANS - AKA pyrosis
-retrosternal can radiate to throat, shoulder, back
-belching
-lying WORSENS symptoms
GERD diagnosis - ANS FIRST - before get invasive - try acid suppression medications
- endoscopy
-manometry
24-hour pH testing
GERD treatment - ANS -avoid stimulants (coffee/caffeine, chocolate)
-sit up after eating
-HOB increases (can use blocks or wedge booster)
squamous cell esophageal cancer - ANS linked to smoking and alcohol use
,adenocarcinoma esophageal cancer - ANS linked to GERD and Barrett's esophagus
manifestations of esophageal cancer - ANS - progressive dysphagia
- unintentional weight loss = anorexia
- pain
- fatigue
treatment of esophageal cancer - ANS - depends on tumor stage (poor prognosis)
gastric mucosal barriers - ANS protective mucosal barrier
- 2 main causes which are Aspirin and NSAID use, and infection
gastritis - ANS inflammation of gastric mucosal
peptic ulcer disease - ANS - ulcerative disorder in the upper GI tract that are exposed to acid-pepsin
secretions
(erosion in one or all layers of the stomach or duodenum)
most common peptic ulcer disease - ANS - duodenal (5x more common)
- gastric (average age middle and older adults)
causes of peptic ulcer disease - ANS H. pylori produces an enzyme that breaks down urea --- h.
pylori-bacterial infection
- NSAID inducer
(NSAIDS and Aspirin)
peptic ulcer disease manifestations - ANS - burning, gnawing, cramp-like
- pain in small area midline in epigastric near xyphoid
- stomach is empty
- pain CAN BE relived from food or antacids
,what screening to do with peptic ulcer disease? - ANS H. pylori screening
treatment for H.pylori - ANS - antibiotics - avoid NSAIDS and Aspirin, as well as, anticoagulants
- cauterize vessels and insert a balloon to dilate
stress ulcers - ANS - GI ulcers can develop in relation to major physiological stress
- Types are Curling's and Cushing
curling stress ulcer - ANS - gastric stress ulcer in severely ill patients
- burns, trauma, sepsis, ARDS
- ischemia to mucosa and alteration in gastric mucosa barrier
cushing stress ulcer - ANS - with intracranial injury (traumatic brain injury TBI) operation, tumors
causes: hyper secretion of gastric acid
stomach cancer etiology - ANS nitriso compounds benopyrene
manifestations of stomach cancer - ANS early: indigestion and burning
late: bloating after meals, and pain NVD/C
- Wt. loss, bleeding melena
stomach cancer DX and TX - ANS DX: barium xray
TX: gastrectomy
crohn's disease - ANS anywhere GI tract
ulcerative colitis - ANS colon and rectum
etiology of inflammatory bowel disease - ANS - unregulated and over-active immune response
against bacteria in the normal intestinal flora of susceptible individuals
- genetic predisposition
, - environmental trigger or infectious trigger
crohn's disease - ANS - granulomas type inflammatory response
- slowly progressive relentless
- onset of 20s and 30s
- sharply demarcated granulomatous lesions
- can lead to fibrosis and obstruction
crohn's disease manifestations - ANS - diarrhea, colicky pain, wt. loss
- occasional, but less bloody diarrhea compared to UC
- fluid and electrolyte disturbance
- malaise, low-grade fever
- absorption surface altered
complications of crohn's disease - ANS - increase risk of infection or abscesses
crohn's treatment - ANS - unable to cure, but goal = minimize discomfort and negative effects -
remission
ulcerative colitis - ANS - peak incidence 15-25 years
- confined to colon - usually begins in the rectum
- contiguous manner NOT skipping
- pinpoint mucosal hemorrhages develop into abscesses which can become necrotic and ulcerate,
bleeding common
- tongue like projections = pseudopolyps
etiology of ulcerative colitis - ANS - immune system dysfunction
- genetics
- changes in gut flora
- environmental triggers
DX of ulcerative colitis - ANS - sigmoid colonoscopy and Bx
