Peptic Ulcer and Gastric Health Quiz
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Questions and Answers

What is the most common type of peptic ulcer?

  • Marginal ulcer
  • Autoimmune ulcer
  • Gastric ulcer
  • Duodenal ulcer (correct)
  • Which of the following is NOT a common cause of peptic ulcer disease?

  • NSAIDS
  • Autoimmune disorders (correct)
  • Severe stress
  • H. pylori infection
  • What are the most common symptoms of peptic ulcer disease?

  • Severe abdominal pain
  • Gnawing, burning, aching epigastric pain (correct)
  • Nausea and vomiting
  • Bloating and belching
  • What is a potential complication of peptic ulcer disease?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is a characteristic of acute peptic ulcers?

    <p>Shallow lesions (A)</p> Signup and view all the answers

    Which of the following is a risk factor for peptic ulcer disease?

    <p>Use of NSAID medications (A)</p> Signup and view all the answers

    Which of these statements about H. pylori is NOT true?

    <p>It is a common cause of stomach cancer. (D)</p> Signup and view all the answers

    What is the most common type of gastric cancer?

    <p>Adenocarcinoma (A)</p> Signup and view all the answers

    What should be done if a patient presents with abdominal discomfort and is suspected of having peptic ulcer disease?

    <p>Refer the patient for an endoscopy. (C)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for gastric cancer?

    <p>High consumption of fruits and vegetables (B)</p> Signup and view all the answers

    What is the most common cause of acquired diaphragmatic hernia?

    <p>Blunt force trauma (C)</p> Signup and view all the answers

    Which of the following is a characteristic symptom of pyloric stenosis?

    <p>Projectile vomiting (D)</p> Signup and view all the answers

    What is the primary diagnostic tool used for pyloric stenosis?

    <p>Abdominal ultrasound (C)</p> Signup and view all the answers

    Which of the following is a treatment option for congenital diaphragmatic hernia?

    <p>Surgery (A)</p> Signup and view all the answers

    What is the typical presentation of congenital diaphragmatic hernia in neonates?

    <p>Respiratory distress (A)</p> Signup and view all the answers

    Which of the following is a possible complication of diaphragmatic hernia?

    <p>Strangulation of organs (A)</p> Signup and view all the answers

    What is the primary mechanism of action of PPIs (proton pump inhibitors) in the treatment of GERD?

    <p>Reduce acid production (A)</p> Signup and view all the answers

    What is the most common cause of acute gastritis?

    <p>NSAID use (A)</p> Signup and view all the answers

    What is the main difference between GERD and a diaphragmatic hernia?

    <p>A diaphragmatic hernia involves protrusion of organs into the chest cavity (D)</p> Signup and view all the answers

    Which of the following statements is TRUE about massage and diaphragmatic hernia?

    <p>Massage should be avoided or done with light pressure over the affected area (C)</p> Signup and view all the answers

    What is the most common symptom of hiatal hernia?

    <p>Indigestion (B)</p> Signup and view all the answers

    Which type of hiatal hernia has a fixed protrusion of a separate portion of the stomach into the thorax?

    <p>Paraesophageal hernia (C)</p> Signup and view all the answers

    What is the most common complication of paraesophageal hernias?

    <p>Strangulation (B)</p> Signup and view all the answers

    Which of the following is NOT a lifestyle change recommended for managing sliding hernias?

    <p>Increasing exercise intensity (B)</p> Signup and view all the answers

    What is the primary treatment for paraesophageal hernias that cause symptoms?

    <p>Surgical repair (B)</p> Signup and view all the answers

    What is the definition of GERD?

    <p>Inflammation of the esophagus due to backflow of stomach acid (A)</p> Signup and view all the answers

    Which of the following risk factors is NOT associated with GERD?

    <p>Low-fat diet (C)</p> Signup and view all the answers

    Which of the following drugs can interfere with the function of the LES and contribute to GERD?

    <p>Anticholinergics (C)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of GERD?

    <p>Constipation (A)</p> Signup and view all the answers

    Which of the following complications of GERD can cause dysphagia, shortness of breath, and wheezing?

    <p>Stricture (B)</p> Signup and view all the answers

    What is a characteristic symptom of a gastric ulcer that distinguishes it from a duodenal ulcer?

    <p>Pain that is worse with an empty stomach (D)</p> Signup and view all the answers

    What is the most common complication associated with peptic ulcer disease?

    <p>Bleeding (C)</p> Signup and view all the answers

    Which of the following is a characteristic symptom of gastric outlet obstruction caused by peptic ulcer disease?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the classic perforation triad associated with peptic ulcer perforation?

    <p>Sudden onset abdominal pain, tachycardia, abdominal rigidity (B)</p> Signup and view all the answers

    What is the medical term for the healing process that can lead to excessive scarring in peptic ulcer disease?

    <p>Cicatrization (D)</p> Signup and view all the answers

    What is the primary cause of peptic ulcers that can lead to cancer?

    <p>Helicobacter pylori (H. pylori) infection (B)</p> Signup and view all the answers

    What is the most likely reason for increased night pain in patients with duodenal ulcers?

    <p>Increased acid output at night (B)</p> Signup and view all the answers

    What is a potential complication of peptic ulcer disease that involves the formation of a passageway between the stomach or duodenum and an adjacent organ?

    <p>Fistula (B)</p> Signup and view all the answers

    Which of the following is considered a common deficiency in Celiac Disease?

    <p>Iron (C)</p> Signup and view all the answers

    What is the defining characteristic of Crohn's Disease compared to Ulcerative Colitis?

    <p>The inflammation involves the full thickness of the bowel (transmural inflammation). (C)</p> Signup and view all the answers

    Which of the following is considered a common extraintestinal symptom of Crohn's Disease?

    <p>Enteropathic Arthritis (B)</p> Signup and view all the answers

    Which of the following is NOT a common complication of Ulcerative Colitis?

    <p>Skip lesions (B)</p> Signup and view all the answers

    Which of the following statements regarding Celiac Disease is TRUE?

    <p>Treatment involves a gluten-free diet and corticosteroids. (D)</p> Signup and view all the answers

    What is the main characteristic of Malabsorption Syndrome?

    <p>Compromised nutrient absorption through the small and/or large intestine. (C)</p> Signup and view all the answers

    Which of the following symptoms is specifically associated with fat malabsorption in Malabsorption Syndrome?

    <p>Light-colored, soft, foul-smelling stools that float (B)</p> Signup and view all the answers

    Which of the following statements regarding massage in patients with Crohn's Disease is TRUE?

    <p>Abdominal massage is generally always contraindicated during flare-ups. (C)</p> Signup and view all the answers

    Which of the following statements about Celiac Disease is CORRECT?

    <p>Celiac Disease can lead to complications such as iron-deficiency anemia due to malabsorption. (A)</p> Signup and view all the answers

    Which of the following is a characteristic symptom of Ulcerative Colitis?

    <p>Diarrhea often associated with blood and mucus. (B)</p> Signup and view all the answers

    Which of the following is a serious complication of Ulcerative Colitis that can lead to urgent colectomy?

    <p>Severe bleeding. (B)</p> Signup and view all the answers

    What is the primary aim of treatment for Inflammatory Bowel Disease?

    <p>Relief of symptoms and reduction of inflammation. (D)</p> Signup and view all the answers

    Which of the following is a potential consequence of long-standing Crohn's Disease involving the colon?

    <p>Increased risk of colon cancer. (A)</p> Signup and view all the answers

    Which of the following is a common symptom of protein malabsorption in Malabsorption Syndrome?

    <p>General swelling (edema). (C)</p> Signup and view all the answers

    Which of the following statements regarding massage in patients with Malabsorption Syndrome is TRUE?

    <p>Massage around the abdomen may need to be adjusted or avoided depending on the patient's symptoms. (B)</p> Signup and view all the answers

    What is the primary diagnostic tool for Ulcerative Colitis?

    <p>Sigmoidoscopy and/or barium studies. (C)</p> Signup and view all the answers

    Flashcards

    Gastritis

    Inflammation of the stomach lining, causing symptoms like dyspepsia and nausea.

    Peptic Ulcer Disease (PUD)

    Ulcerations in the stomach or duodenum, can be acute or chronic, mostly caused by H. pylori.

    Acute PUD

    Shallow gastric lesions without immune response, often linked to NSAID use.

    H. pylori

    Bacterium causing gastric and duodenal ulcers, found in 90% of duodenal ulcer cases.

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    Signs of PUD

    Common symptoms include gnawing epigastric pain, hematemesis, and bloating; often asymptomatic.

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    Duodenal Ulcer

    An ulcer located in the first few inches of the duodenum.

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    Gastric Ulcer

    An ulcer that occurs in the gastric antrum or near the pylorus.

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    Epigastric Pain

    Pain in the upper middle region of the abdomen, often after eating.

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    Gastroduodenal Dysmotility

    Impaired movement of the stomach and duodenum, leading to symptoms.

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    Classic Perforation Triad

    The three signs of perforation: sudden pain, tachycardia, rigidity.

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    Fistula Formation

    Abnormal connection between the stomach/duodenum and another organ.

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    Gastric Outlet Obstruction

    Narrowing of pyloric antrum due to inflammation or scarring.

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    Hematemesis

    Vomiting blood, which can appear bright red or like 'coffee grounds'.

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    Paraesophageal Hernia (Type II)

    A fixed protrusion of a portion of the stomach into the thorax while the LES remains below the diaphragm.

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    Sliding Hernia (Type I)

    Protrusion of the LES and gastroesophageal junction through the diaphragm, causing dilation.

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    Signs and Symptoms of Hiatal Hernia

    Most are asymptomatic; common symptoms include indigestion and chest pain, especially after eating.

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    Complications of Paraesophageal Hernia

    Strangulation can occur, leading to chest pain and loss of blood supply to the stomach.

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    Barium X-ray

    Diagnostic tool used to visualize the esophagus and stomach for abnormalities like hiatal hernias.

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    Gastroesophageal Reflux Disease (GERD)

    Backflow of stomach acid into the esophagus, causing inflammation and potential erosion.

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    Risk Factors for GERD

    Factors like hiatal hernia, obesity, pregnancy, and certain foods/drinks contributing to GERD.

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    Signs and Symptoms of GERD

    Common symptoms include heartburn, regurgitation, and throat pain; can also cause bleeding.

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    Complications of GERD

    Chronic reflux can lead to esophageal ulcers, strictures, and Barrett’s esophagus.

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    Barrett’s Esophagus

    Metaplastic changes in the esophagus lining due to chronic acid exposure; may occur without symptoms.

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    Pylori Infection Risk

    Increases risk of Peptic Ulcer Disease by 3-6 times.

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    Peptic Ulcer Diagnosis

    Diagnosis involves characteristic abdominal pain and tests like endoscopy or barium x-ray.

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    Peptic Ulcer Treatment

    Treatment includes stopping NSAIDs, antibiotics for H.pylori, and acid-reducing medications.

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    Gastric Cancer Definition

    Primarily adenocarcinomas from the stomach's glandular cells, making up 95% of cases.

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    Gastric Cancer Risk Factors

    Includes H.pylori infection, gastric polyps, certain dietary factors, smoking, and obesity.

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    GERD

    A chronic digestive condition where stomach acid flows back into the esophagus.

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    Diagnosis of GERD

    Based on symptoms; no tests needed to start treatment initially.

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    Diaphragmatic Hernia

    Protrusion of organs into the thoracic cavity through a weakened diaphragm.

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    Congenital Diaphragmatic Hernia

    A birth defect where there's a defect in the diaphragm affecting neonates.

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    Signs of Diaphragmatic Hernia

    Symptoms include abdominal pain, decreased breath sounds, and potential bulge.

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    Pyloric Stenosis

    A condition where the pylorus narrows, blocking food passage to the duodenum.

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    Symptoms of Pyloric Stenosis

    Persistent projectile vomiting after feeding and visible peristalsis.

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    Acute Gastritis

    Transient inflammation of the gastric mucosa, often caused by NSAIDs.

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    Pyloromyotomy

    Surgical treatment for pyloric stenosis involving muscle splitting.

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    Complications of Diaphragmatic Hernia

    Can include incarceration of organs leading to strangulation and perforation.

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    Celiac Disease

    An autoimmune disorder triggered by gluten, leading to intestinal damage.

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    Common deficiencies in Celiac

    Iron, Calcium, Vitamin D, B12, and Protein deficiencies are common.

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    Diagnosis of Celiac Disease

    Suspected based on symptoms, confirmed with blood tests and biopsy.

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    Treatment for Celiac Disease

    A gluten-free diet and corticosteroids are primary treatments.

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    Inflammatory Bowel Disease (IBD)

    A group of inflammatory disorders of the gastrointestinal tract.

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    Crohn's Disease

    A type of IBD characterized by transmural inflammation and 'skip lesions'.

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    Ulcerative Colitis (UC)

    An autoimmune disease with inflammation limited to the colon's mucosal layer.

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    Symptoms of Crohn's Disease

    Common symptoms include abdominal pain, diarrhea, and fatigue.

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    Complications of Ulcerative Colitis

    May include severe bleeding, toxic megacolon, and increased risk of colon cancer.

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    Malabsorption Syndrome

    Compromised absorption of nutrients through the intestines.

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    Signs of Malabsorption

    Includes weight loss, steatorrhea, and nutrient-specific symptoms.

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    Diagnosis of Malabsorption

    Based on symptoms, weight loss, and tests for specific nutrients.

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    Treatment of Malabsorption

    Treatment depends on the underlying cause and replaces lost nutrients.

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    Massage and Celiac Disease

    No contraindications, but abdominal massage may need adjustment.

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    Massage and Inflammatory Bowel Disease

    Local contraindication during flare-ups; discuss comfort with patients.

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    Study Notes

    Gastrointestinal System Diseases - Part 1

    • Disorders of the esophagus include hiatal hernia and GERD.
    • Hiatal hernia: protrusion of stomach through the esophageal hiatus.
    • Affects about 15% of the population, possibly rising to 60% in people over 60.
    • Presentation ranges from minor reflux to severe reflux, indigestion, bloating, and dysphagia.
    • Etiology includes age-related diaphragm changes, trauma, large hiatus, intense pressure on surrounding muscles (coughing, vomiting, straining), and obesity.
    • Two types of hiatal hernias: Sliding (Type I, 95%) and Paraesophageal (Type II, 5%).
    • Sliding hernia: the LES and gastroesophageal junction protrude through the diaphragm, producing a bell-shaped dilation.
    • Paraesophageal hernia: a separate portion of the stomach protrudes into the thorax, while the LES and gastroesophageal junction remain below the diaphragm.
    • Symptoms: Most sliding hernias are asymptomatic or have minimal symptoms, commonly indigestion after eating, dull chest pain, shortness of breath (SOB), heart palpitations, symptoms often intensified with trunk flexion, straining, lifting, or pregnancy, microscopic or massive bleeding is rare.
    • Complications: strangulation (painful and emergency complication of paraesophageal hernia), stomach pinched by diaphragm, losing blood supply, chest pain, bloating, belching, dysphagia.
    • Diagnosis: barium X-ray
    • Treatment: lifestyle changes (raising bed head, eating smaller meals, avoiding foods before bed, weight loss, quitting smoking, looser clothing, eliminating cola, acidic juices, alcohol, coffee, and spicy/fatty foods), H2 blockers or PPIs.
    • Treatment for paraesophageal hernias: surgical repair to prevent strangulation.
    • Massage Considerations: local contraindication, avoid or only light pressure over effective area, be conscious of patient positioning and comfort.

    Gastroesophageal Reflux Disease (GERD)

    • Backflow of stomach acid and enzymes into the esophagus causes esophageal inflammation (reflux esophagitis).
    • Stomach lining has mucus-secreting cells to protect against acid.
    • Esophagus lacks protective lining.
    • Acid causes inflammation and erosion.
    • Etiology: LES dysfunction, hiatal hernia, obesity, pregnancy, fatty foods, chocolate, caffeinated/carbonated drinks, alcohol, smoking, certain drugs (anticholinergics, calcium channel blockers, progesterone, nitrates).
    • Symptoms: heartburn, regurgitation, pain in neck, throat, face, sore throat, hoarseness, excessive salivation, sensation of lump in throat, dry cough.
    • Complications: esophageal ulcers, chronic reflux, stricture, Barrett's esophagus (metaplastic changes), dysphagia, SOB, wheezing.
    • Diagnosis: based on symptoms, no diagnostic tests needed to start treatment, special testing when unclear or treatment fails (endoscopy, x-rays, LES pressure measurement, esophageal pH testing).
    • Treatment: lifestyle changes (similar to hiatal hernia), eating habits, avoiding irritating foods, parasympathetic stimulators to close LES, H2 blockers, or PPIs.
    • Massage Considerations: no contraindications, be mindful of positioning and timing of massage.

    Disorders of the Stomach

    • Include diaphragmatic hernia, pyloric stenosis, gastritis, peptic ulceration, and gastric cancer.

    Diaphragmatic Hernia

    • Protrusion of organs into thoracic cavity through a weakening in the diaphragm (not esophageal hiatus).
    • Stomach and/or intestines push through weakened opening.
    • Etiology: congenital (embryologic defect) or acquired (blunt trauma).
    • Signs: abdominal pain, decreased breath sounds, SOB, bowel sounds in chest, potential bulge, many adults without symptoms.
    • Complications: incarceration of organs, strangulation (perforation and peritonitis), surgical emergency.
    • Treatment: surgical repair (within 24-48 hours for congenital, as soon as possible for acquired).
    • Prognosis: recurrence possible, but rare, routine check-ups with CXR and PFTs.
    • Massage Considerations: local contraindication, avoid or only light pressure over effective area, be conscious of patient positioning and comfort.

    Pyloric Stenosis

    • Congenital or acquired pyloric hypertrophy causing a blockage between the stomach and duodenum.
    • Pylorus function: keeps food in stomach for digestion, then relaxes to release food into duodenum.
    • Results in gastric outlet obstruction, preventing stomach emptying into the small intestine and causing food to back up into the esophagus.
    • Etiology: congenital (more common), idiopathic hypertrophy apparent within the first month of life, potential genetic component, linked to other genetic/congenital conditions (Turner syndrome, Trisomy 18, esophageal atresia, 3-4x more common in males), acquired (pyloric hypertrophy related to gastritis or peptic ulcers near gastric antrum).
    • Signs and Symptoms: regurgitation, projectile vomiting after feeding, dehydration and FTT, infants appear hungry after vomiting, palpable olive-sized mass visible on PE.
    • Diagnosis: Abdominal US.
    • Treatment: surgical muscle splitting (pyloromyotomy), IV fluids to correct dehydration.
    • Massage Considerations: local contraindication.

    Acute Gastritis

    • Transient, self-limiting inflammation of the gastric mucosa with neutrophilic infiltration.
    • Characterized by hemorrhagic defects that extend through mucosa with sloughing of the superficial mucosa.
    • Etiology: NSAIDs (aspirin), H. pylori, EtOH, smoking, Crohn's, emotional stress, increased acid production, decreased mucous production, severe body stress, illness or injury with severe burns or bleeding (ischemia of mucosal lining).
    • Signs and Symptoms: often no symptoms but may include epigastric pain/pressure, indigestion, nausea/vomiting, overt hemorrhage, massive hematemesis, melena, anemia (fatigue, weakness, light-headedness).
    • Complications: ulceration/significant bleeding, gastric perforation/peritonitis, gastric atrophy leading to chronic gastritis.

    Chronic Gastritis

    • Inflammation of the gastric mucosa with infiltration of lymphocytes and plasma cells and associated with mucosal atrophy and intestinal metaplasia.
    • Stomach lining thins (atrophy), leading to loss of acid-producing cells.
    • Etiology: autoimmune, environmental (H. pylori is the most common cause), NSAIDs (aspirin), EtOH, smoking, Crohn's disease.
    • Signs and Symptoms: usually asymptomatic, or vague, mild dyspepsia, poor digestion, decreased protein breakdown (if HCI secretion is reduced), malabsorption, pernicious anemia, and polyneuropathies (lack of B12).
    • Treatment: discontinue and avoid drugs that aggravate gastritis, eradicate H. pylori (triple therapy with PPIs and two antibiotics), avoiding irritants (aspirin and NSAIDs).
    • Massage Considerations: local contraindication, avoid abdominal massage.

    Peptic Ulcer Disease (PUD)

    • Ulcerations in the lining of the stomach.
    • Can be acute or chronic.
    • Acute: shallow gastric lesions with no immune response related to NSAIDs.
    • Anatomic classifications: Duodenal (most common type in first few inches duodenum, related to gastric juice, and digestive enzymes), Gastric (commonly occurs along lesser curvature near antrum of stomach), Marginal (where removed part stomach has been anastomosed to intestine).
    • Etiology: imbalance in gastroduodenal mucosal defense mechanisms (HCl, pepsin), most commonly related to H. pylori infection (90% duodenal ulcers, 75% gastric ulcers), other causes include NSAIDs, corticosteroids, sever stress, smoking.
    • Signs and Symptoms: 70% asymptomatic, gnawing, burning, or aching epigastric pain, pain can wax/wane (periods of weeks/months), other possible symptoms: hematemesis, bloating, or belching.
    • Complications: excessive scarring, gastric outlet obstruction, cancer, perforation (tearing through anterior wall of stomach or duodenum into the abdominal cavity), severe bleeding (hemorrhage of friable tissue), possible mortality rate of ~10%, melena, and hematochezia.
    • Diagnosis: suspicion of characteristic abdominal pain, tests: endoscopy or barium X-ray, used when treatment fails to resolve symptoms (especially if >45 and suffering from weight loss).
    • Treatment: discontinue any NSAID or other irritants, antibiotics for H. pylori infection, neutralize stomach acid with over-the-counter or prescription drugs (4-8 weeks).
    • Massage considerations: local contraindication, if patient has abdominal discomfort avoid abdominal massage.

    Gastric Cancer

    • Primary adenocarcinomas from glandular cells of the stomach (95% of cases).
    • Epidemiology: most common in older adults (>50), highest incidence in eastern Asia, lowest in Africa, more common in males, >4000 diagnoses per year in Canada, 5th most common cancer, 3rd highest mortality rate worldwide.
    • Etiology: H. pylori infection, large or multiple gastric polyps, dietary factors (smoked, salted, pickled foods, nitrates), smoking, obesity.
    • Signs and Symptoms: early symptoms vague and may mimic peptic ulcers (burning pain, early satiety), possible weight loss, abdominal pain, nausea, dysphagia (difficulty swallowing), melena, early satiety, and ulcer pain. Possible late-stage diagnosis indicated by enlarged L supraclavicular lymph node (Virchow's node).
    • Diagnosis: suspicion of abdominal pain, weight loss, and/or history of gastric ulcers or chronic gastritis, confirmed with upper endoscopy and biopsy.
    • Prognosis: 5-year survival rate is 10%, worse prognosis with late diagnosis and metastatic disease, better prognosis if cancer hasn't spread too deeply.
    • Treatment: surgical excision of large portion of stomach and local lymph nodes, may be palliative to relieve obstruction and allow food passage, chemotherapy and radiation have limited effectiveness beyond palliative care.
    • Massage considerations: no contraindications, be aware of patient comfort in certain positions.

    Disorders of the Intestines

    • Includes celiac disease, inflammatory bowel disease (Crohn's and ulcerative colitis), and malabsorption syndrome.

    Celiac Disease

    • Aka celiac sprue, non-tropical sprue, gluten enteropathy.
    • An immune disorder triggered by gluten (a protein in wheat, barley, and oats) in genetically predisposed individuals.
    • Genetic component in 10% of cases.
    • Pathophysiology: immune response to gluten ingestion causing inflammation, flattening of villi in small intestine, and widespread malabsorption.
    • Risk factors: having 1st or 2nd degree relatives with celiac disease (genetic), often associated with other autoimmune diseases (Type 1 diabetes, autoimmune thyroiditis), and genetic syndromes (Down's Syndrome, Turner Syndrome).
    • Symptoms: range depends on severity of damage to the small intestine, often including gastrointestinal signs (chronic diarrhea, foul-smelling stools, bloating, malnutrition, weight loss), malabsorption with deficiencies (iron anemia, calcium/vit D, B12, protein), and extraintestinal signs (dermatitis herpetiformis a skin rashes).
    • Diagnosis: symptoms raise suspicion, followed-up with blood and stool antibody tests, confirmed with biopsy.
    • Treatment: gluten-free diet, sometimes corticosteroids.
    • Prognosis: potential risk for developing intestinal lymphoma and GI cancer, unknown if a gluten-free diet decreases risk, but there is a small absolute increase in overall mortality in patients with celiac compared to general population.
    • Massage considerations: no contraindications.

    Inflammatory Bowel Disease (IBD)

    • Two main types: Crohn's disease and ulcerative colitis.

    Crohn's Disease

    • Immune-mediated inflammatory disease characterized by transmural inflammation.
    • Can involve any part of GI tract, from oral cavity to perianal area.
    • Characteristic “skip lesions.”
    • Etiology: idiopathic, autoimmune condition, immune mediated inflammation, transmural inflammation and damage to GI tract.
    • Pathophysiology: full thickness (transmural) inflammation of bowel, most commonly affecting the distal ileum or proximal colon, and skip lesions are common in affected patients (80% of patients have small bowel involvement with usually distal ileum), skip lesions (80% of cases), 1/3 of patients have ileitis exclusively.
    • Signs and symptoms: early symptoms of abdominal pain, diarrhea (with or without gross bleeding), fatigue, and weight loss, abdominal pain can manifest with cramping quality, and extraintestinal signs include: enteropathic arthritis: (primarily involves larger joints; may also include sacroiliitis or ankylosing spondylitis), uveitis, erythema nodosum, pyoderma gangrenosum, and stomatitis; gallstones and renal stones.
    • Complications: flare-ups, can be mild or severe, brief or prolonged, tend to reappear in the same areas, obstruction from scarring, abscesses and/or fistula formation, increased risk of colon cancer with longstanding disease in colon (similar to UC).
    • Diagnosis: GP suspicion based on history of crampy abdominal pain and diarrhea, anal issues, physical exam may reveal palpable lump or fullness in RLQ, stool inflammatory markers, autoimmune markers, confirmation via colonoscopy w/ biopsy and/or barium x-ray, may not be useful if limited to small intestine.
    • Treatment: no cure, aims at relieving symptoms and reducing inflammation (antidiarrheal, anti-inflammatories, corticosteroids, dietary changes), may resolve without medication, surgical removal of segments of small intestine or colon may be required, and can recur in any location in the GI tract.
    • Massage considerations: local contraindication during flare-ups, no massage over affected area, discuss patient comfort level

    Ulcerative Colitis

    • Chronic, autoimmune disease characterized by recurring inflammation limited to the mucosal layer of the colon (limited to the large intestine, progressive, continuous lesions).
    • Etiology: idiopathic, autoimmune condition, genetic connection, dietary and infections can trigger or exacerbate inflammation.
    • Epidemiology: symptoms generally begin between ages 15-30; however a smaller number of patients do not experience symptoms until ages 50-70.
    • Signs and Symptoms: diarrhea (often with blood), possible bowel urgency and incontinence, left lower quadrant (LLQ) pain, if limited to rectum, stool is dry but may have mucus, white blood cells (WBCs), and red blood cells (RBCs) in the stool, if extends to entire colon, looser stool and more frequent bowel movements, extraintestinal signs (enteropathic arthritis involving large peripheral joints), uveitis, erythema nodosum, pyoderma gangrenosum.
    • Complications: severe bleeding, possible urgent colectomy, iron deficiency anemia, toxic megacolon (massive colon distention), possible perforation, increased risk of colon cancer (more common if entire colon is affected).
    • Diagnosis: history of symptoms, stool sample, confirmation with sigmoidoscopy/barium studies, followed by colonoscopy to determine the extent of damage.
    • Treatment: aimed at controlling inflammation, reducing symptoms, replacing lost fluids/nutrients, antidiarrheal, anti-inflammatory drugs, corticosteroids, dietary changes, iron supplements, avoidance of raw fruits/vegetables; colectomy, may be curative.
    • Massage considerations: local contraindication during flare-ups, no massage over affected area, discuss patient comfort level.

    Malabsorption Syndrome

    • Absorption through the small and/or large intestine is compromised.
    • Multiple causes, but usually related to damage to mucous membrane (damage to the mucous membrane of the GI tract).
    • Signs and Symptoms: Depend on nutrients not absorbed, common symptoms: weight loss, light-colored/soft/foul smelling stools (steatorrhea, float in water, difficult to flush), explosive diarrhea, bloating, flatulence, generalized swelling, dry skin, hair loss, bone pain, risk of fractures, muscle spasms, tooth decay, iron deficiency anemia (fatigue & weakness), MG, night blindness, wet/dry Beriberi, glossitis, angular cheilitis, pellagra (beefy glossitis), folate/B9 (fatigue & weakness), Vitamin B12, nerve damage, scurvy (connective tissue weakness), osteomalacia (softening of bone), and vitamin K deficiency (bleeding) .
    • Diagnosis: based on symptoms & weight loss despite healthy diet, blood tests to determine malabsorbed nutrients, stool samples to assess fat content (>7g fat/day), potential biopsy to determine underlying cause.
    • Treatment: treat underlying cause.
    • Massage considerations: no contraindications, depending on symptoms massage near abdomen may need adjusted/avoided.

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    Test your knowledge on peptic ulcer disease and related gastric conditions. This quiz covers symptoms, causes, complications, and risk factors associated with peptic ulcers and gastric cancer. Perfect for medical students or anyone interested in gastrointestinal health.

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