________ is the most powerful predictor of developing type 2 diabetes mellitus.
Obesity
Congenital adrenal hyperplasia (adrenogenital syndrome) results from
blocked cortisol production.
In type I diabetes, respiratory compensation may occur through a process of
respiratory alkalosis.
Proton pump inhibitors may be used in the management of peptic ulcer disease to
decrease hydrochloric acid (HCl) secretion.
Antidiuretic hormone (ADH) increases
water reabsorption in the collecting tubule of the kidney.
A patient who should be routinely evaluated for peptic ulcer disease is one who is
being treated with high-dose oral glucocorticoids.
An infusion of mannitol would be prescribed to treat
cerebral edema.
A clinical finding that is consistent with a diagnosis of adrenocortical insufficiency is
hypoglycemia.
A clinical finding consistent with a hypoglycemic reaction is
tremors.
Diabetes mellitus is the ________ leading cause of death and a major cause of disability in the United States.
seventh
The formation of active vitamin D
is impaired in renal failure.
Epigastric pain that is relieved by food is suggestive of
gastric ulcer.
Celiac sprue is a malabsorptive disorder associated with
inflammatory reaction to gluten-containing foods.
What clinical finding would suggest an esophageal cause of a client’s report of dysphagia?
Chest pain during meals
Myxedema coma is a severe condition associated with
hypothyroidism.
A clinical finding consistent with a diagnosis of syndrome of inappropriate ADH secretion (SIADH) is
hyponatremia.
Surgical removal of a gland may result in
hyposecretion.
A thyroid gland that grows larger than normal is known as
goiter.
A laboratory finding that would help confirm the diagnosis of hyperaldosteronism is
hypokalemia.
Which response to an injection of ACTH indicates a primary adrenal insufficiency?
Which response to an injection of ACTH indicates a primary adrenal insufficiency?
Narcotic administration should be administered carefully in patients with acute pancreatitis related to potential for
sphincter of Oddi dysfunction.
Fecal leukocyte screening would be indicated in a patient with suspected
enterocolitis.
Elevated serum lipase and amylase levels are indicative of
pancreatitis.
Pathophysiologically, esophageal varices can be attributed to
portal hypertension.
An urgent surgical consult is indicated for the patient with acute abdominal pain and
absent bowel sounds.
A viral hepatitis screen with positive hepatitis B surface antigen (HBsAg) should be interpreted as ________ hepatitis B.
acute
A patient with a history of alcoholism presents with hematemesis and profound anemia. The expected diagnosis is
gastroesophageal varices.
A patient being treated for hepatic encephalopathy could be expected to receive a(n) ________ diet.
low-protein and high-fiber
Chronic pancreatitis may lead to
diabetes mellitus.
The definitive treatment for cholecystitis is
cholecystectomy.
More than half of the initial cases of pancreatitis are associated with
alcoholism.
A patient admitted with bleeding related to esophageal varices could be expected to receive a continuous intravenous infusion of
octreotide acetate.
Liver transaminase elevations in which aspartate aminotransferase (AST) is markedly greater than alanine aminotransferase (ALT) is characteristic of
alcohol-induced injury.
Hepatitis B is usually transmitted by exposure to
blood or semen.
A patient with chronic gastritis would likely be tested for
Helicobacter pylori.
Premature infants are at greater risk for developing
necrotizing enterocolitis.
Normal bile is composed of
water, electrolytes, and organic solutes.
A biliary cause of acute pancreatitis is suggested by an elevation in which serum laboratory results?
Alkaline phosphatase
The finding of hypotension, rigid abdomen, and absent bowel sounds in a patient with pancreatitis
Indicates peritonitis with substantial risk for sepsis and shock.
Common manifestations of gastrointestinal tract disorders:
What is the manifestations of esophageal pain?
Heart burn (pyrosis) and Chest pain
(esophageal distention or obstruction)
Common manifestations of gastrointestinal tract disorders:
What is the manifestation of abdominal pain?
Visceral pain, somatic pain, and referred pain.
Common manifestations of gastrointestinal tract disorders:
When is acute abdominal pain felt?
When you have perforated ulcer or ruptured organ
Common manifestations of gastrointestinal tract disorders:
When is chronic abdominal pain felt?
Diverticulitis or Ulcerative colitis
TRUE/FALSE
Vomiting is a common manifestation of gastrointestinal tract disorders.
True
Common manifestations of gastrointestinal tract disorders:
What are the 3 manifestations of intestinal gas?
Belching, abdominal gas and flatus
Common manifestations of gastrointestinal tract disorders:
What are bowel pattern alterations that can happen in gastrointestinal tract disorders?
Constipation and diarrhea.
What is dysphagia?
Difficulty swallowing
What sensation is felt with dysphagia?
Sensation that swallowed solids/liquids "stick" in esophagus
TRUE/FALSE
Patients with dysphagia have pain with swallowing?
True, and it is referred to as odynophagia.
In dysphagia the patient has the __________ to initiate swallowing
inability
What type of dysphagia?
- Problems in delivery of fluid/food into esophagus
-May be caused by R/T neuromuscular incoordination disorders
-May be caused when the normal sequence is altered or absent
Type 1
What are the clinical manifestations of type 1 dysphagia?
May _________ & ____________ the __________ ___________ & _____________.
- _____________ when attempting to swallow
-___________ with liquids than solids
May cough & expel the ingested food & liquids.
- Aspirate when attempting to swallow
-Worse with liquids than solids
What type of dysphagia?
-Problems in transport of bolus down esophagus.
Causes:
-Outpuching of one or more layer (diverticula)
-Disorder of smooth muscle function (achalasia)
-Structural interference of esophageal peristaltic activity (neoplasms, strictures)
-Abnormal peristaltic activity
Type II
What are the clinical manifestations of type II dysphagia?
-Sensation that ______ is "________" behind __________
-Initially with ______ _______ may progress to __________.
Sensation that food is "stuck" behind sternum
Initially with solid food, may progress to liquids.
What type of dysphagia?
- Problems in bolus entry into stomach
Causes: Lower esophageal dysfunction or lesion obstruction
Type III
What are the clinical manifestations of type II dysphagia?
______ or _______ in substernal area during ________ process.
Tightness or pain in substernal area during swallowing process.
What is the esophageal disorder that causes backflow of gastric contents into esophagus through LES
GERD (gastroesophageal reflux disease)
What are the causes of GERD
*There are 7 :(
fatty foods, caffeine, large amounts of alcohol, cigarette smoking, pregnancy, anatomic features, hiatal hernia
What are the clinical manifestations of GERD
Heartburn, regurgitation, chest pain, dysphagia
What are treatments used for GERDS?
There are 3 important ones
Over the counter antacids and histamine (H2)- blocking medications
Proton pump inhibitors (PPI) are the mainstays for chronic GERD
What is an important complication in GERD that can become esophageal cancer?
Barrett esophagus
Complication of GERD in which columnar tissue replaces normal squamous epithelium of the distal esophagus?
Barrett esophagus
What are pulmonary symptoms of Barrett esophagus?
cough, asthma, and laryngitis
(from reflux in breathing passages)
What can progression of Barrett esophagus cause?
ulceration and fibrotic scarring
What is gastritis?
Inflammation of the stomach lining
Acute gastritis is precipitated by _________ or ___________ ___________.
Acute gastritis is precipitated by ingestion of irritating substances.
What are examples that will cause acute gastritis?
Alcohol and asprin, NSAIDs, viral, bacteria and autoimmune
Chronic gastritis will become......
peptic ulcer and gastric adenocarcinoma
What is always nearly a factor of chronic gastritis?
Helicobacter pylori
(transmission: person to person, fecal-oral route, reservoir in water sources)
What are complications of chronic gastritis?
* 4 of them - not so bad :)
Peptic ulcer disease, gastric adenocarcinoma, decreased acid and intrinsic factor.
TRUE or FALSE
Gastric adenocarcinoma is deadly and can cause MALT
TRUE
What will not be absorbed if you have decreased intrinsic factor?
B-12
What are causes of peptic ulcer disease?
* 4 of them :)
NSAIDs, stress (glucocorticoids), smoking, genetics
What is a key role in promoting both gastric and duodenal ulcer formation?
H.pylori
In what situations does H.pylori thrive and what does it cause?
in acidic conditions. It causes slow rate of ulcer healing, and high rates of recurrence
What promotes ulcer healing?
Clearance of H.pylori
Pain of ________ ________ typically occurs on an empty stomach but may present soon after a meal.
Pain of gastric ulcer typically occurs on an empty stomach but may present soon after a meal.
Pain of _________ _________ classically occurs 2-3 hours after a meal and is relieved by further food ingestion.
Pain of duodenal ulcer classically occurs 2-3 hours after a meal and is relieved by further food ingestion.
If you have pain at night is it most likely gastric or duodenal ulcer?
duodenal
Gatric ulcers should be visualized with ____________ and _______________ to rule out _____________.
Gastric ulcers should be visualized with endoscopy and biopsied to ruled our malignancy.
Treatment for peptic ulcer disease:
Encourage _______ of the ___________ _________ by __________ gastric ________.
Prevent ___________.
__. _______ antibiotics
_____ antagonits
__________ ________ inhibitors
____________ (forms protective coating over injured mucosa)
Encourage healing of the injured mucosa by reducing gastric acidity.
Prevent recurrence
H. pylori antibiotics
H2 antagonist
Proton pump inhibitors
Sucralfate (from protective coating over injured mucosa)
Life style changes used as treatment for peptic ulcer disease:
___________ cessation
Avoidance of _____ and ________
_________ reduction
Avoid ______ ________ that exacerbate symptoms such as __________ ________ (sadness) and __________ (double sadness)
Smoking cessation
Avoidance of ASA and NSAIDs
Stress reduction
Avoid irritating foods that exacerbate symptoms such as caffeinated beverages (sadness) and alcohol (double sadness)
What is the inflammatory bowel disease that causes chronic inflammatory disease of the mucosa of the rectum and colon (Lower end)?
Ulcerative colitis
What are the hallmark manifestations for ulcerative colitis?
Ulceration and remission.
Bloody diarrhea and lower abdominal pain
TRUE/FASLE
Patients with ulcerative colitis don't have increased cancer risk.
False. They do, colon cancer, usually 7-10 yrs after 1st manifestation
What are the main two treatments for ulcerative colitis?
Corticosteroids and broad-spectrum antibiotics.
*Just for fun, a new medication is MAB.
What type of inflammatory bowel disease affects all layers of intestinal wall of proximal portion of the colon or terminal ileum?
Crohn Disease aka regional enteritis or granulomatous colitis.
Clinical manifestations for Crohn disease?
diarrhea, if blood not as severe as ulcerative colitis, constant chronic right lower quadrant pain, may have RLQ mass and tenderness
What is antibiotic-associated colitis?
Enterocolitis
What causes acute inflammation and necrosis of large intestine?
Enterocolitis
What is enterocolitis caused by?
Our BFF:
C-DIFF (exposure to antibiotics)
Clinical manifestations of enterocolitis
Bloody diarrhea, abdominal pain, fever, leukocytosis, sepsis
Fun fact:
HISTORY IS CRITICAL for patients with enterocolitis
you need to know if they've been taking previous antibiotics and which type.
Treatment for enterocolitis:
STOP ______ _______.
________ _______ such as metronidazole or vancomycin
Stop current antibiotics
Oral antibiotics such as metronidazole or vancomycin
Gina's favorite entercolitis is.....
APPENDICITIS hahaha :)
FYI its pretty rare in adults mostly common in kids
Inflammation of the vermiform appendix causes....
appendicitis
Clinical manifestations of appendicitis
RLQ pain (McBurney point) rebound tenderness, nausea, vomiting, fever, diarrhea
Treatment for appendicitis
immediate surgical removal
Antibiotics with fluid/electrolyte replacement
Type of enterocolitis where presence of diverticula in the colon
Diverticular disease
Diverticular disease results from low intake of ......
dietary fibers
What motility disorder causes alternating diarrhea and constipation accompanied by abdominal cramping pain?
*most common
IBS- Irritable bowel syndrome
IBS is also called _______ ______ and ______ _______ syndrome
IBS is also called spastic colitis and irritable colon syndrome
Clinical manifestations of IBS?
Diarrhea or constipation, abdominal cramping, and mucus in stool.
What motility disorder causes twisting of bowel on itself causing intestinal obstruction and blood vessel compression (ischemia)
*seen in elderly
Volvulus
Motility disorder where telescoping/invagination of a portion of bowel into adjacent (usually distal) bowel, causing intestinal obstruction.
*most often in infants- males more than females
Intussusception
Malabsorption disorder that is familial intolerance of gluten-containing foods leading to inflammation and atrophy of intestinal villi.
Celiac disease
Treatment for celiac disease
Gluten-free diet, supplemental iron folate, B12 fat-soluble vitamins (A.D,EK), and oral corticosteroids.
What are warning signs of neoplasms of GI tract?
Black tarry, bloody, or pencil-shaped stool, and a change in bowel habit
Who are more likely to get esophageal cancer, men or women?
Men by (3x)
What are 3 main risk factors for esophageal cancer?
nitrosamine, Barrett esophagus, and smoking
What is the most likely prognosis for a patient with esophageal cancer?
Poor, very high degree of metastasis
What are the two types of esophageal cancer
squamous cell carcinoma
adenocarcinoma
Who are more likely to get gastric carcinoma, men or women?
Men who are older than 30yrs old
What is the 1 main risk factor for gastric carcinoma?
H. pylori infection
Who are most likely to get small intestinal neoplasms?
ha not men,
people 50 years or older
What neoplasm of the GI tract has a major precursor lesion in the development of colon cancer?
Colonic polyps
Can Epstein barr virus case gastric carcinoma?
yes
What are the risk factors for colon cancer
-Don't say smoking. It's not there. For once.
Increases after age 40
high-fat, low fiber diet
polyps
chronic irritation or inflammation
hereditary
What are the majority of gallstones made of?
Cholesterol (75%)
*pigment (25%)
What are the three factors that contribute to the formation of gallstones:
1. ____________ of bile with ________ causing _________ of cholesterol.
2. ____________ of crystals
3.___________ (stasis of bile) allowing stone _________.
1. Supersaturation of bile with cholesterol, causing precipitation of cholesterol.
2. Nucleation of crystals
3. Hypomotility (stasis of bile) allowing stone growth.
What determine the likelihood of cholesterol gallstone formation?
Concentration of cholesterol, lecithin, and bile acids.
Risk factors for gallstones?
6 of them :(
-Prolonged fasting or rapid weight loss
-Pregnancy
-Oral contraceptives
-Obesity
-Women over 40
-Variety of medical factors.
What percentage of Gallstones are pigment stones?
25%
Contains a mixture of pigment polymers and calcium salts.
Pigment stones
Pigment stones that are the most common and may be idiopathic or associated with cirrhosis or hemolysis.
Black pigment stones
Differ in composition, much more common in developing countries, associated with biliary parasitosis, bacterial colonization, and infection.
Brown pigment stones
Do adults who have cholelithiasis need treatment?
No and they may be asymptomatic.
What disorder of the gallbladder associated with inflammation of the gallbladder wall and causes fibrosis and thickening?
Cholecystitis
What is the most common cholecystitis?
Calculus cholecystitis caused by gallstones.
Acute or chronic cholecystitis?
-Cholelithiasis present in 90% of patients
-Obstruction of cystic duct present in almost all patients: related to stasis of bile
-Bacterial infection may be present.
Acute cholecystitis
What is used to make a diagnosis of acute cholecystitis?
Abdominal Ultrasound
Clinical manifestations of acute cholecystitis:
-Severe ______ _______ abdominal pain: radiates to ______.
-__________ tenderness
-___________
-___________
-mild elevations of _________ and serum _______________.
-Severe right upper abdominal pain: radiates to back.
-abdominal tenderness
-Fever
-leukocytosis
-mild elevations of bilirubin and serum transaminases.
*It is important to note fever and leukocytosis are not seen in patients with gallstones-that's the difference
What are the two main treatments for cholecystitis?
Cholecystectomy and antibiotics
TRUE or FALSE
Acalculous cholecystitis is caused because of gallstones?
False
-Occurs in patients without preexisting gallstones.
-Males 50 years or older ( >50)
-Tends to occur in the setting of major surgery, critical illness, trauma, burn-related injury or TPN
Acalculous cholecystitis
Inflammation of the pancreas, autodigestion of the pancreas from enzyme activation.
Acute pancreatitis
What are predisposing factors associated with acute pancreatitis?
* 3 of them :)
Biliary tract disease, hypertriglyceridemia, alcohol (66%)
99% of pancreas is _________.
Exocrine. (It produces enzymes)
*Just 1% of the pancreas creates insulin- endocrine
The 3 pathways for acute pancreatitis:
___________ of the pancreatic _________ by a ______ or other cause (usually unknown)
- __________ cell injury
-____________ intracellular transport
Obstruction of the pancreatic duct by a stone or other cause (usually unknown)
-Acinar cell injury
-Defective intracellular transport
*all 3 will lead to activated enzymes (protease, protein breakdown, fat necrosis, damage of basal membrane, hemorrhage, and cause inflammation and edema)
Clinical manifestations of acute pancreatitis:
Steady, boring pain in _______ or _____.
- __________ in intensity
-___________ tenderness on palpitation
-______ or _________ to back
-________ and __________.
Steady boring pain in epigastrium or LUQ
- Increases in intensity
-Severe tenderness on palpation
-Radiates or penetrates to back
-Nausea and vomiting
What are the general manifestations in hepatocellular failure
Jaundice, decreased clotting factors, hypoalbuminemia, decreased vitamins D and K.
What are the general manifestations in portal hypertesnsion
GI congestion, development of esophageal or gastric varices, hemorrhoids, splenomegaly, ascites
Hemolysis, ineffectve erythropeiesis, resorption of large hemattomas is a sign of what
Prehepatic causes - red blood cell or spleen
Dysfunction of liver cells: increased levels of either unconjugated or conjugated bilirubin; imatrue UDPGT are signs of what?
Hepatic causes - Liver
At level of canalicular bilirubin transport, cinjugated hyperbilirubinemia, mechanical obstruction to bile ducts is a sign of what
Post hepatic causes- bile and bile bladder
What is the preferred test to diagnosis acute pancreatitis?
Lipase and amylase blood test.
in acute pancreatitis, when will there be an increase in amylase and lipase?
during the first 12 hrs.
In what diagnostic testing will ileus pattern, "sentinel loop." show a distended loop of small bowel in the area of the pancreas in a patient who has acute pancreatitis?
Abdominal x-ray
TRUE or FALSE
it is difficult to see acute pancreatitis in an abdominal ultrasound
True
What is the best diagnostic tool "gold standard" for diagnosing acute pancreatitis?
*not preferred, the best
CT of abdomen
What is the treatment used for mild to moderate acute pancreatitis?
Reduce pancreatic secretions, conservation management, and withholding oral feeding
What type of acute pancreatitis complication is the following:
Collection of fluid within or adjacent to the pancreas. A patient will experience fever, tachycardia, abdominal mass, and tenderness.
Pseudocyst
What management is done for pseudocyst?
endoscopic or surgical drainage
What type of pancreatitis:
-Chronic inflammatory lesions in pancreas.
-Associated with alcohol intake
-Can progress even if alcohol consumption is stoped
Chronic pancreatitis
What type of acute pancreatitis complication is the following:
Persistent leak in pancreatic duct into pleural space and mediastinum.
Pancreatic ascites
Pathogenesis of Chronic Pancreatitis:
-Presence of chronic __________ lesions in ____________.
-Key element: necrosis of ______ _______ followed by __________.
-Leads to ___________ which cause __________ flow of ___________ juices.
-Presence of chronic inflammatory lesions in pancreas.
-Key element: necrosis of exocrine parenchyma followed by fibrosis.
-Leads to calcification which cause obstructed flow of pancreatic juices.
Clinical manifestations of chronic pancreatitis:
Bouts of acute pancreatitis with progressive ______ and ________ pancreatic dysfunction.
-___________: progressive loss of pancreatic islets
-___________: fat and vitamin A, D, E. and K
-___________: poor intake related to pain
Bouts of acute pancreatitis with progressive endocrine and exocrine pancreatic dysfunction.
-Diabetes: progressive loss of pancreatic islets
-Malabsorbtion: fat and vitamin A, D, E. and K
-Weightloss: poor intake related to pain
What are the two important complications of chronic pancreatitis?
Pseudocysts and pancreatic ascites.
Treatment for chronic pancreatitis:
- ________ control
- Absolute abstention from __________.
-_________ intervention
-_______ _______ block.
- Pain control
- Absolute abstention from alcohol.
-Surgical intervention
-Celiac plexus block.
What type of cancer?
-About 2% of all cancers
-Ranks 4th among deaths from malignancies
Pancreatic cancer
Two risk factors for pancreatic cancer?
Cigarette smoking and obesity
Clinical Manifestations for pancreatic cancer:
_______ _______ ________: jaundice, malabsorption,and weight loss
__________ ______: abdominal pain and nausea
k
Diabetes Insipidus/ DI is caused by
ADH Deficiency
What are the three P's for Diabetes Insipidus
- Polyuria
- Polydipsia
- Polyphagia
Insulin is synthesized in the pancreas by the _____ ______ of the islets of ____________.
______ ______ produce glucagon
Insulin is synthesized in the pancreas by the Beta cells of the islets of Langerhans.
Alpha cells produce glucagon