Essentials of Pathophysiology – Exam #2 Review
Covers Modules 4, 5, and 6 – Chapters 7, 8, 9, 10
1. What is gastritis? What are
... [Show More] causes?
• Inflammation of the stomach lining, precipitated by ingestion of irritating substances such as alcohol, aspirin, NSAIDs, viral, bacterial, autoimmune. Clinical manifestations: anorexia, n/v, postprandial discomfort, hematemesis. Treatment: remove offending agent.
2. Review the etiology and clinical manifestations of GERD. What are complications of GERD if left untreated?
• Gastroesophageal Reflux Disease (GERD): backflow of gastric reflux into the esophagus through
lower esophageal sphincter (LES); inflammation caused by reflux of highly acidic material (esophagitis). Caused by any condition or agent that alters closure strength of LES or increases abdominal pressure, fatty foods, caffeine, large amounts of alcohol, cigarette smoking, pregnancy, anatomic features. Clinical manifestations- heartburn, regurgitation, chest pain, dysphagia. Treatment- Enhancing esophageal clearance, improving gastric emptying, suppressing gastric acidity, avoiding tobacco, and aggravating food and drink, over the counter antacids and histamine (H2)- blocking medications for occasional GERD.
• Complications- barrett esophagus: columnar tissue replaces normal squamous epithelium of
the distal esophagus. Carries a significant risk for esophageal cancer. Progression can lead to ulceration, fibrotic scarring, esophageal strictures, pulmonary symptoms- cough, asthma, and laryngitis- from reflux and breathing passages.
3. Review the etiology and clinical manifestations of peptic ulcer disease (PUD).
• Causes: no relation between PUD and diet, caused by NSAIDs, stress (glucocorticoids), smoking, and genetics. H. pylori: key role in promoting both gastric and duodenal ulcer formation, thrives in acidic conditions (slow rate of ulcer healing and high rate of recurrence), clearance of H. pylori provides ulcer healing. Clinical manifestations: epigastric burning pain that is usually relieved by intake of food (especially dairy products) or antacids, gastric ulcers- typically occurs on an empty stomach but may present soon after a meal, duodenal ulcer- occurs 2-3 hours after a meal and is relieved by further food ingestion, life threatening complications such as GI bleeding may occur without warning.
4. Review the etiology and clinical manifestations for pseudomembranous colitis.
• Acute inflammation and necrosis of large intestine, caused by clostridium difficile (exposure to antibiotics), mediated by bacterial toxins. Clinical Manifestations: Diarrhea (often bloody), abdominal pain, fever, leukocytosis, sepsis, colonic perforation (rare). Treatment: stop current antibiotic (if possible), treat ischemia, treat contributing conditions, oral antibiotics, recurrence common, fecal transplant (transferring fecal of healthy person to the source patient), colectomy (removal of portion colon).
5. Review signs and symptoms of appendicitis.
• Inflammation of the vermiform appendix, obstruction of the fecalith. Clinical manifestations: periumbilical pain, RLQ pain “Mcburney’s point”, nausea, vomiting, fever, diarrhea, RLQ tenderness, systemic signs of inflammation.
6. Review causes of bowel obstructions. Know the difference between functional bowel obstructions versus mechanical obstructions. Know examples of each type.
• Intestinal obstruction: Partial or complete blockage of small or large intestine. Common site is
the small intestine. Contributing factors include previous abdominal surgery with adhesions,
congenital abnormalities of the bowel, metastatic carcinoma, particularly cancer of the intestinal tract or female reproductive organs. Fluid, gas, water, and electrolytes accumulate in the bowel. Mechanical: adhesions, hernia, tumors, impacted feces, volvulus, intussusception. Functional: paralytic ileus, due to conditions that inhibit peristalsis, such as certain medications (such as anticholinergics), opioids, lower fiber diets, etc. [Show Less]