Path Exam 4| study guide verified A+

Path Exam 4| study guide verified A+Path Exam 4| study guide verified A+ gastroesophageal reflux disease (GERD) - correct answer-- symptoms produced by abnormal reflux of gastric contents into the esophagus, oral cavity, or the lungs. - weak lower sphincter leads to reflux. - decreased sphincter tone from alcohol, fatty foods, heavy smoking, caffeine, chocolate, peppermint. - other factors include pregnancy, obesity, gastroparesis, large meals, bending over, tight clothes. GERD acute symptoms - correct answer-- most frequent symptoms is severe heartburn 30-60 mins after eating. - increased when lying down - sore throat - dyspepsia - dysphagia - respiratory symptoms including cough, wheezing, hoarseness - chest pain GERD chronic complications - correct answer-- metaplasia change - persistent reflux leading to hyperemia or increased blood flow, esophagitis, edema, erosion of mucosal surface of esophagus. - strictures: narrowing of esophagus leading to dysphagia (" it feels like food is stuck in my throat") - Barrett esophagus: stratified squamous mucosa replaced by columnar epithelium (esophageal adenocarcinoma). Gastric Mucosal Barrier - correct answer-- stomach lining impermeable to stomach acid secretion - gastric mucosal barrier: helps prevent autodigestion 1. impermeable epithelial cell surface 2. thick mucus layer 3. bicarbonate secretion maintains pH balance 4. prostaglandins: increased mucosal blood flow, decreased acid secretion, increased bicarbonate secretion, and increased mucus production. - substances that disrupt mucosal barrier and damage cells below leads to erosion (Aspirin or NSAIDs). - ulcerations from acid seeping into small punctures or cuts. disorders of the stomach - correct answer-1. acute gastritis 2. chronic gastritis 3. peptic ulcers (stress, gastric, duodenal) acute gastritis - correct answer-- acute inflammation of gastric mucosa - vomiting, gastric pain, ulceration, hemorrhage - causes: 1. NSAIDs, aspirin, corticosteriods 2. alcohol 3. bacterial toxins like food poisoning (typically abrupt and 5 hours after ingestion). - self limiting meaning that the mucosa will repair itself - typically goes away in 24-48 hours. chronic gastritis - correct answer-- chronic inflammation of gastric mucosa leads to erosion, atrophy of glandular epithelium. - Helicobacter pylori (H. Pylori) gastritis is the most common chronic gastritis. - diagnosis: carbon urea breath test, stool antigen test, biopsy. - treatment: antibiotics and proton pump inhibitors. H. pylori - correct answer-- chronic infection that leads to gastric atrophy and peptic ulcers - bacteria highly immunogenic leads to intense immune repose in gastric mucosa, neutrophils, B cells, T cells, cytokines. Peptic ulcers - correct answer-- disease: group of ulcerative disorders that occur in areas of gastric and intestinal mucosa that are exposed ti acid-pepsin secretions. - risk factors that cause acute and chronic gastritis lead to peptic ulcers: H. pylori infection, chronic ASA and NASAID use, alcohol, smoking, stress. peptic ulcers classification - correct answer-- depth: erosion, acute ulcer, chronic ulcer - location: duodenal ulcers (postpyloric) or gastric ulcers (prepyloric) - whether it heals or comes back? - how far it tunnels down. peptic ulcers: duodenal - correct answer-- located in the duodenum - most common - young male adults - usually from smoking, alcohol, family history of PUD - intermittent mid epigastric pain (chest and abdomen join in the middle) that comes 2-5 hours after eating, pain relived with antacids or food. - first symptoms include perforation (GI bleeding) with NSAID use. - spontaneous remission and exacerbations leading to intermittent healing pattern (eating more makes you feel better). peptic ulcers: gastric - correct answer-- located in the stomach - older adults more than younger adults - females more than males. - intermittent upper epigastric pain that occurs immediately after eating or 1-2 hours after eating - chronic ulcers activate inflammatory mediators leading to increased acid and pepsinogen production and gastric mucosal disruption and ulceration. - left gastric artery affected. Erosion leading to hemorrhage. - if it gets far enough into the vascular tissue than it ulcerates into blood vessels causing GI bleeding. peptic ulcers: stress - correct answer-- GI ulcerations that develop in relation to major physiological stress. - severe burns, trauma, sepsis, ARDS, liver failure, major surgery, ICU stay. - located in the funds and body of the stomach - manifestations: painless upper GI tract bleeding. throw up blood. - Preventative therapy for hospitalized patients with PPIs. inflammatory bowel disease - correct answer-- autoimmune - chronic disease and ulcerative colitis - shared characteristics: 1. inflammation of lower bowel without known causative agent. 2. familial occurrence - systemic manifestations: 1. arthritis, uveitis, skin lesions, autoimmune anemia, hyper coagulability, stomatitis. 2. activation of inflammatory cells and mediators. - remissions and activations of diarrhea, fecal urgency, weight loss. - most symptoms are patient specific and hard to diagnosis from each symptom. Crohn disease - correct answer-- recurrent, granulomatous inflammatory response - affects any area of GI tract - characterized by skip lesions such as granulomatous lesions which are interspersed between appearing bowel segments. Also has a cobblestone appearance. - granulomatous which are areas of inflammation that include macrophages, epithelioid cells, multinucleate giant cells. - creates fistulas, abscess, and ulcers. Chrohn Disease Manifestations - correct answer--intermittent diarrhea - RLQ colicky pain (can be anywhere and comes/goes) - weight loss - electrolyte and fluid imbalances - malaise - low grade fever. Chrohn disease complications - correct answer-- fistulas - abdominal abscess - intestinal obstruction - malabsorption of nutrients - infection - abscess Chrohn disease treatment - correct answer-- diet should include high vitamins, calories proteins and low in fat. - medications. Chrohn disease: fistulas - correct answer-- openings not where they should be normally that create abscess: 1. bowel/colon 2. bowel/vagina 3. bowel/urethra 4. bowel/skin 5. bowel/bladder ulcerative colitis - correct answer-- nonspecific inflammation of colon - confined to rectum and colon - confluent and continuous - inflammatory lesions: necrotic and ulcerate - only the large bowel and does not ulcerate through the wall. ulcerative colitis manifestations - correct answer-relapsing disorder marked by extensive attacks of diarrhea with blood and mucous in the stools, abdominal cramping, fecal incontinence, anorexia, weakness, fatigue. ulcerative colitis complications - correct answer-increased risk of colon cancer ulcerative colitis treatment - correct answer-- diet should include avoiding caffeine, milk, spicy foods, gas-forming foods, fiber supplements - surgery includes colectomy with colostomy. diverticulitis - correct answer-- inflammation of the diverticula - manifestations: none, LLQ pain, N/V. - causes: lack of dietary fiber, sedentary lifestyle, poor bowel habits, aging - complications: perforation, hemorrhage, fistula. diverticulum - correct answer-single out pouching of hollow structure in the body. diverticula - correct answer-many out pouching go mucosa and submucosa. diverticulosis - correct answer-diverticula that are not inflamed. appendicitis - correct answer-- inflammation of wall of the appendix leading to swelling, necrosis, gangrene, perforation. - intraluminal obstruction - early manifestations: abrupt onset of pain referred to epigastric or periumbilical area. - later pain moves to RLQ with rebound tenderness - treatment: antibiotics, surgery - complications: peritonitis, abscess formation, sepsis. celiac disease - correct answer-- immune mediated disorder triggered by ingestion of gluten containing grains like wheat, barley, rye. - genetic disease caused by T cell mediated immune response against alpha-gliadin fraction of gluten. - increased levels of antibodies to alpha-gliadin leading to inflammatory reaction and loss of absorptive villi from the small intestine. - malabsorption of macronutrients (proteins, carbs, fats) and micronutrients (vitamins and minerals) - some people can be come anemic because of iron absorptions. celiac disease manifestations - correct answer-- diarrhea and abdominal pain - increased in infancy: diarrhea, abdominal dissension, failure to thrive, muscle wasting, severe malnutrition. celiac disease treatment - correct answer-- remove gluten and related proteins from diet. - no wheat, barley, rye, or malt - rice oats and potatoes are okay. Detrusor muscle - correct answer-- Smooth muscle that compresses the urinary bladder and expels urine into the urethra. contraction occurs during urination. - stimulated by the parasympathetic cholinergic motor fibers to contract. innervation of the bladder - correct answer-- innervated by pelvic nerves - When the bladder is full, stretch receptors in the bladder wall are activated and this impulse is transmitted to the sacral region of the spinal cord. - relaxation of the internal sphincter causes release of urine from the bladder. - somatic control of the external sphincter allows for voluntary release of urine. micturition - correct answer-act of passing urine internal sphincter of bladder - correct answer-smooth muscle, involuntary, autonomic external sphincter of bladder - correct answer-skeletal muscle, voluntary, somatic bladder volumes - correct answer-- total urine volume produced in 24 hours should be between 750 to 2000 mL (30mL/hr min). - when the bladder is holding 150 to 250 mL of urine the sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex. - a person will feel the sensation of fullness when the bladder contains 400-500 mL of urine. Formula to determine urine output - correct answer-- typically used if a patient is at risk for kidney problems, hypovolemic shock, or urination problems. - 0.5-1 mL/kg/hr. - should be about 30-60 mL/hr in a 60kg person. What can bladder volume and urine characteristics help determine? - correct answer-cardiac output, dehydration, urinary problems, etc... postvoid residual volume - correct answer-Amount of urine remaining in the bladder within 15 minutes of voiding Adequate postvoid residual volume - correct answer-less than 50 mL inadequate postvoid residual volume - correct answer-more than 200 mL and can be signs of urinary retention or obstruction. polyuria - correct answer-- urine output gr