Digestive 1 sys path round 2
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Questions and Answers

What is the most common cause of Peptic Ulcer Disease (PUD)?

  • NSAIDS
  • Severe stress
  • Corticosteroids
  • H. pylori (correct)
  • Which type of peptic ulcer is most commonly found in the first few inches of the unprotected duodenum?

  • Duodenal (correct)
  • Antral
  • Marginal
  • Gastric
  • What is the primary reason for the development of Peptic Ulcer Disease (PUD)?

  • An increase in the production of gastric acid
  • An increase in the consumption of spicy foods
  • An increase in the consumption of alcohol
  • A decrease in the protective mucosal layer of the stomach and duodenum (correct)
  • What is a possible complication of Peptic Ulcer Disease (PUD)?

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

    What is a common symptom of Peptic Ulcer Disease (PUD)?

    <p>Gnawing, burning, aching epigastric pain (C)</p> Signup and view all the answers

    What types of hiatal hernias are generally asymptomatic or have mild symptoms?

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

    Which of the following is NOT a risk factor for developing GERD?

    <p>High fiber diet (B)</p> Signup and view all the answers

    What complication is MOST likely to occur with a paraesophageal hernia?

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

    What is a common symptom of GERD?

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

    What is the primary cause of GERD?

    <p>Malfunction of the LES (B)</p> Signup and view all the answers

    Which of the following drugs may interfere with the function of the LES?

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

    What is Barrett's esophagus?

    <p>A change in the lining of the esophagus (B)</p> Signup and view all the answers

    Which of the following is a possible treatment for hiatal hernia?

    <p>H2 blockers (B)</p> Signup and view all the answers

    What is the MOST appropriate treatment for a paraesophageal hernia that causes symptoms?

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

    What is the MAIN difference between a sliding hernia and a paraesophageal hernia?

    <p>Location of the hernia (A)</p> Signup and view all the answers

    What is the primary diagnostic test for gastric cancer?

    <p>Upper endoscopy with biopsy (D)</p> Signup and view all the answers

    Which of the following symptoms is MOST commonly associated with gastric cancer?

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

    Which of the following is a risk factor for celiac disease?

    <p>Family history of celiac disease (D)</p> Signup and view all the answers

    What is the pathophysiological mechanism underlying celiac disease?

    <p>Immune response to gluten causing inflammation and villous atrophy (A)</p> Signup and view all the answers

    What is the most common physical exam finding associated with metastatic gastric cancer?

    <p>An enlarged left supraclavicular lymph node (Virchow's node) (D)</p> Signup and view all the answers

    What is the protein found in wheat, barley, and oats that triggers celiac disease?

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

    What is the five-year survival rate for gastric cancer?

    <p>10% (D)</p> Signup and view all the answers

    Which of the following conditions is NOT associated with celiac disease?

    <p>Irritable Bowel Syndrome (B)</p> Signup and view all the answers

    What is the most common type of gastric cancer?

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

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

    <p>High intake of fresh fruits and vegetables (C)</p> Signup and view all the answers

    In the context of Peptic Ulcer Disease (PUD), which of the following is a valid reason for endoscopy?

    <p>To confirm PUD diagnosis when treatment fails to resolve symptoms. (D)</p> Signup and view all the answers

    What is the primary function of medications used to treat PUD, apart from antibiotics?

    <p>To neutralize or reduce stomach acid. (A)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the incidence of gastric cancer?

    <p>Eastern Asia has the highest incidence rates of gastric cancer. (A)</p> Signup and view all the answers

    In the context of chronic gastritis, what is the primary function of the cells that are lost due to thinning of the stomach lining?

    <p>Secretion of digestive enzymes and acid (C)</p> Signup and view all the answers

    What is the most common environmental cause of chronic gastritis?

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

    Which of the following is NOT a common symptom of acute gastritis?

    <p>Severe abdominal cramping (C)</p> Signup and view all the answers

    What is the primary difference between acute and chronic gastritis regarding their duration?

    <p>Acute gastritis lasts for 1-6 months, while chronic gastritis lasts for over 6 months. (C)</p> Signup and view all the answers

    Besides H.pylori, what other factors are mentioned as potential causes of chronic gastritis?

    <p>Autoimmune disorders, alcohol, NSAIDs (B)</p> Signup and view all the answers

    Which of the following is a potential complication of untreated acute gastritis?

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

    What is the typical treatment approach for chronic gastritis caused by H.pylori?

    <p>Proton pump inhibitors and antibiotics (C)</p> Signup and view all the answers

    When should massage be adjusted or avoided in patients with celiac disease?

    <p>When the patient is experiencing abdominal pain. (D)</p> Signup and view all the answers

    What is the most common early symptom of Crohn's disease?

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

    Which of the following is a common extraintestinal manifestation of Crohn's disease?

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

    What is a potential complication of Crohn's disease that can lead to obstruction?

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

    What is the most common complication of ulcerative colitis?

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

    Which of the following is a characteristic feature of toxic megacolon?

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

    What is the most common general symptom of malabsorption syndrome?

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

    Which of the following is a characteristic symptom of fat malabsorption?

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

    What is a potential complication of calcium malabsorption?

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

    Which of the following is a possible symptom of iron malabsorption?

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

    Which of the following is a possible symptom of vitamin B12 malabsorption?

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

    What is the recommended treatment for malabsorption syndrome?

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

    What is the most common reason for malabsorption syndrome?

    <p>Damage to the mucous membrane of the GI tract (D)</p> Signup and view all the answers

    What is the most accurate way to diagnose malabsorption syndrome?

    <p>Stool sample analysis (B)</p> Signup and view all the answers

    What is the best way to confirm the diagnosis of Crohn's disease?

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

    What is the primary objective of treatment for Crohn's disease?

    <p>To relieve symptoms (A)</p> Signup and view all the answers

    Flashcards

    Sliding Hernia (Type I)

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

    Paraesophageal Hernia (Type II)

    Fixed protrusion of part of the stomach into the thorax, while LES stays below the diaphragm.

    Hiatal Hernia Symptoms

    Most sliding hernias are asymptomatic; common symptoms include indigestion and chest pain.

    Gastroesophageal Reflux Disease (GERD)

    Backflow of stomach acid into the esophagus causing inflammation (reflux esophagitis).

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    GERD Signs and Symptoms

    Common symptoms include heartburn and regurgitation; pain may extend to neck and throat.

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    Complications of GERD

    Include esophageal ulcers, strictures, and Barrett's esophagus due to chronic reflux.

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    Barrett's Esophagus

    Metaplastic changes of the esophagus lining due to acid irritation.

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    Diagnosis of Hiatal Hernia

    Often diagnosed using a barium x-ray to visualize the esophagus and stomach.

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    Lifestyle Changes for Hiatal Hernia

    Recommended changes include sleeping with head elevated and avoiding certain foods.

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    Treatment for Paraesophageal Hernia

    Surgical repair may be needed if symptoms occur, to prevent complications like strangulation.

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    Peptic Ulcer Disease (PUD)

    Ulcerations in the stomach or duodenum lining, can be acute or chronic.

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    H.pylori

    Bacteria present in most cases of duodenal and gastric ulcers.

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    Symptoms of PUD

    Common symptoms include gnawing pain, nausea, and hematemesis.

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    Types of ulcers

    Gastric, duodenal, and marginal ulcers based on location.

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    Complications of PUD

    Can lead to iron-deficiency anemia, hemorrhage, or perforation.

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    Acute Gastritis

    Inflammation of the gastric mucosa with abrupt onset, often asymptomatic.

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    Chronic Gastritis

    Long-term inflammation of the gastric mucosa, often asymptomatic with gradual onset.

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    Signs of Acute Gastritis

    Common signs include epigastric pain, nausea, and sometimes vomiting; severe cases may show bleeding.

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    Signs of Chronic Gastritis

    Often asymptomatic, may cause mild dyspepsia and malabsorption issues.

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    Etiology of Chronic Gastritis

    Common causes include H.pylori, NSAIDs, alcohol, smoking, and autoimmune factors.

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    Complications of Acute Gastritis

    Can lead to ulceration, significant bleeding, or even gastric perforation.

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    Treatment for Chronic Gastritis

    Includes stopping aggravating drugs and eradicating H.pylori with triple therapy.

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    Emotional Stress Effect

    Increases acid production and decreases mucus production in the stomach.

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    Gastric Cancer Risk Factors

    Factors that increase the likelihood of developing gastric cancer, including H. pylori infection, diet, and obesity.

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    Diagnosis of PUD

    Diagnosis often involves evaluating abdominal pain and may require tests like endoscopy or barium x-ray.

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    Treatment for PUD

    Includes discontinuing NSAIDs, using antibiotics for H. pylori, and reducing stomach acid for healing.

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    Gastric Cancer Symptoms

    Early symptoms include vague abdominal pain and nausea, resembling peptic ulcers.

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    Common Symptom of Gastric Cancer

    Weight loss is the most common due to nausea and early satiety.

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    Metastatic Finding in Gastric Cancer

    Enlarged left supraclavicular lymph node (Virchow’s node) suggests metastatic disease.

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    Gastric Cancer Diagnosis

    Diagnosis suspected in patients with abdominal pain, weight loss, and history of gastric issues; best confirmed via endoscopy.

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    Gastric Cancer Prognosis

    Five-year survival rate is only 10% due to late diagnosis and metastasis.

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    Celiac Disease Definition

    An immune disorder triggered by gluten in genetically predisposed individuals, causing malabsorption.

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    Signs of Celiac Disease

    Chronic diarrhea, bloating, and malnutrition result from damage to small intestine from gluten.

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    Celiac Disease Risk Factors

    Having relatives with celiac or associated autoimmune diseases increases risk.

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    Celiac Disease Symptoms

    Symptoms include fatigue, anemia, and dermatitis herpetiformis.

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    Celiac Disease Diagnosis

    Diagnosis is confirmed with blood tests and a biopsy.

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    Treatment for Celiac Disease

    A gluten-free diet and corticosteroids are the main treatments.

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    Crohn's Disease Definition

    A chronic inflammatory bowel disease affecting any part of the GI tract.

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    Crohn's Disease Complications

    Flare-ups, abscesses, and increased colon cancer risk are complications.

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    Ulcerative Colitis Symptoms

    Symptoms include bloody diarrhea and abdominal pain in the LLQ.

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    Ulcerative Colitis Complications

    Includes toxic megacolon and increased colon cancer risk.

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    Diagnosis of Ulcerative Colitis

    Diagnosis includes history, symptoms, and sigmoidoscopy.

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    Malabsorption Syndrome Definition

    Compromised absorption through the intestines due to mucosal damage.

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    Symptoms of Malabsorption

    Symptoms vary by nutrient but common include weight loss and steatorrhea.

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    Treatment for Malabsorption

    Treatment is based on the underlying cause of malabsorption.

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    Crohn's Disease Pathophysiology

    Characterized by transmural inflammation, primarily affecting the ileum.

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    Extraintestinal Symptoms of Crohn's

    Conditions like enteropathic arthritis and uveitis can occur.

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    Prognosis for Celiac Disease

    Risk for intestinal lymphoma and increased mortality exists.

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    Complications in Ulcerative Colitis

    Severe bleeding and risk of colectomy are notable complications.

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    Study Notes

    Diseases of the Gastrointestinal System Part 1

    • Disorders covered include those of the esophagus, stomach, inflammatory bowel disease (Crohn's/UC), celiac disease, and malabsorption syndrome.

    Disorders of the Esophagus

    • Hiatal hernia is a protrusion of the stomach through the esophageal hiatus.
    • Approximately 15% of the population has hiatal hernias, potentially rising to 60% in people over 60.
    • Symptoms range from insignificant to severe reflux, indigestion, bloating, and difficulty swallowing.
    • Etiology is often unknown, but risk factors include age-related diaphragm weakening, trauma, surgery, intense pressure on abdominal muscles, and obesity.
    • Two types: Sliding hernia (Type I), which accounts for 95%, and paraesophageal hernia (Type II), which accounts for 5%.
    • Sliding hernia involves the lower esophageal sphincter (LES) and gastroesophageal junction moving through the diaphragm; this creates a bell-shaped dilation.
    • Paraesophageal hernia involves a separate portion of the stomach bulging alongside the esophagus, and the LES sits below the diaphragm.
    • Common symptoms of hiatal hernias include indigestion, heartburn and occasional chest pain, with milder cases being asymptomatic.
    • Complications include strangulation (painful, emergent complication) when the stomach is pinched and loses its blood supply.
    • Diagnosis can be confirmed through a barium x-ray.
    • Treatment for sliding hernias involves lifestyle changes such as raising the head of the bed, adjusting meal timing, controlling weight, and refraining from spicy/fatty foods and alcohol.
    • Treatment of paraesophageal hernias may often involve surgical repair.

    Gastroesophageal Reflux Disease (GERD)

    • Backflow of stomach acid and enzymes into the esophagus causes inflammation (reflux esophagitis).
    • The stomach lining has mucus-secreting cells protecting against acid.
    • The esophagus does not have the same protective barrier, resulting in acid-induced inflammation and erosion.
    • Malfunction of the lower esophageal sphincter (LES) allows the stomach contents to enter the esophagus.
    • Common risk factors include hiatal hernia, obesity, pregnancy, fatty foods, chocolate, caffeinated/carbonated drinks, alcohol, smoking, and certain medications like anticholinergics, calcium channel blockers, and nitrates.
    • Common symptoms include heartburn and regurgitation; pain can also spread to the neck, throat, and face.
    • Other symptoms include sore throat, hoarseness, excessive salivation, sensation of a lump in the throat, and a dry cough.
    • Possible complications include esophageal ulcers, chronic reflux, stricture, dysphagia, shortness of breath, and wheezing, and Barrett's esophagus (metaplastic changes due to acid irritation).
    • Diagnosis is often based on symptoms, but testing including endoscopy, x-rays, LES pressure measurement, and esophageal pH testing is available if needed.
    • Treatment often involves lifestyle changes, avoiding trigger foods, and medication like H2 blockers or PPIs.
    • No contraindications for massage. However, massage timing considerations should be observed.

    Disorders of the Stomach

    • Stomach disorders include diaphragmatic hernia, pyloric stenosis, gastritis, peptic ulceration, and gastric cancer.

    Diaphragmatic Hernia

    • A protrusion of organs into the thoracic cavity through a weakened diaphragm opening (not the esophageal hiatus).
    • Congenital diaphragmatic hernia involves an embryological diaphragm defect, often causing respiratory distress in newborn infants.
    • Acquired diaphragmatic hernia is commonly from blunt force trauma, frequently associated with other thoracic and abdominal injuries.
    • Symptoms include abdominal pain, decreased breath sounds, shortness of breath, audible bowel sounds in the chest, and occasionally, a visible bulge.
    • Complications include incarceration of organs (leading to strangulation and possible perforation), potentially needing emergency surgical repair.
    • Treatment depends on the cause and often involves emergency surgical repair for congenital hernias and delayed surgical repair or ongoing monitoring for acquired types.
    • No contraindications for massage; focus on avoiding pressure over the affected area during massage.

    Pyloric Stenosis

    • Congenital or acquired narrowing of the pylorus (the muscle at the opening between the stomach and the small intestine), hindering food passage.
    • Congenital pyloric stenosis appears in early infancy, often within the first month of life. Possible genetic component. Linked to conditions like Turner syndrome, trisomy 18, and esophageal atresia. Typically 3-4 times more common in males.
    • Acquired pyloric hypertrophy is linked to gastritis or peptic ulcers near the stomach's antrum. –
    • Symptoms include projectile vomiting after feeding, dehydration, and failure to thrive. Physical exam often shows an olive-sized mass in the epigastrium.
    • Treatment is typically surgical (pyloromyotomy) and fluids to correct dehydration.
    • No contraindications for massage. However, avoid massage if symptoms are present or in the affected region.

    Acute Gastritis

    • AKA Erosive Gastritis
    • Characterized by temporary inflammation in the stomach lining due to issues like NSAIDs use, H. pylori infection, or alcohol consumption, smoking, and Crohn's disease.
    • Common symptoms (if any) include epigastric pain, pressure, indigestion, nausea/vomiting, and in severe cases, overt hemorrhage, massive hematemesis, and melena.
    • Symptoms typically resolve on their own.
    • More severe cases could need medical attention to prevent complications like bleeding, perforation, and chronic gastritis.
    • No contraindications for massage. However, avoid abdominal area until recovery if needed.

    Chronic Gastritis

    • Characterized by long-lasting inflammation of the stomach lining with infiltration of lymphocytes and plasma cells, often associated with the thinning of the lining (atrophy) and decreased production of acid and digestive enzymes.
    • Common causes include autoimmune reactions, H. pylori infection, and certain medications like NSAIDS.
    • Symptoms may be vague and mild, often asymptomatic. If symptoms occur, they can include vague/mild indigestion and dyspepsia, poor digestion if HCI secretion decreased. Possible malabsorption, leading to pernicious anemia and neuropathy.
    • Treatment typically includes discontinuing causative agents, medications to reduce stomach acidity(e.g., PPIs), and following proper diet.
    • No contraindications for massage. However, consider patient positioning that minimizes abdominal pressure.

    Peptic Ulcer Disease (PUD)

    • Ulcers or lesions in the stomach lining/duodenum.
    • Categorized as duodenal or gastric ulcers, often linked to an imbalance between the body's defense mechanisms and harmful forces (HCl and pepsin), most commonly H. pylori.
    • Other causes include NSAIDs, corticosteroids, and severe stress.
    • Symptoms frequently include gnawing, burning, or aching epigastric pain, and often wax and wane in severity.
    • Possible complications include perforation (from a leak in the stomach wall) and excessive internal bleeding.
    • Treatment often involves identifying and addressing the cause, e.g., H. pylori antibiotics, discontinuation of NSAIDs, or medication to reduce stomach acid.
    • Patients experiencing abdominal discomfort may need to avoid abdominal massage.

    Gastric Cancer

    • Cancer originating from the glandular cells of the stomach, typically adenocarcinomas.
    • Significant risk factors include H. pylori infection, large/multiple gastric polyps, certain dietary factors (smoked, salted, pickled food, and nitrates), smoking, and obesity.
    • Symptoms initially may be vague and mimic other stomach issues (e.g., initial satiety) but may later include unexplained weight loss, pain, nausea, vomiting, and issues with swallowing.
    • Diagnosis often requires an upper endoscopy with biopsy.
    • Prognosis is often poor, often a poor 5-year survival rate, with early metastasis being a factor.
    • Treatment often requires surgery (partial stomach removal) with chemotherapy and radiation therapy being palliative.
    • No contraindications for massage but be mindful of patient comfort and positioning.

    Disorders of the Intestines: Celiac Disease

    • An immune reaction triggered by gluten (a protein in wheat, barley, and oats).
    • Individuals with celiac disease have a genetic predisposition.
    • Pathophysiology involves immune response to gluten resulting in inflammation and flattening of the villi in the small intestine, leading to malabsorption.
    • Individuals high-risk include those with a family history of celiac, type 1 diabetes, and other autoimmune disorders like autoimmune thyroiditis. Individuals with Down's Syndrome and Turner Syndrome are also at higher risk.
    • Symptoms may include chronic diarrhea (foul smelling), bloating, malnutrition, weight loss, and malabsorption issues. Deficiencies linked include anemia, calcium deficiency (osteopenia), vitamin B12 deficiency, and protein issues. Dermatitis Herpetiformis is a secondary skin manifestation.
    • Treatment involves a gluten-free diet, and corticosteroid use possibly prescribed.
    • No contraindications for massage. However, consider the patient's comfort and symptoms during abdominal massage.

    Inflammatory Bowel Disease (IBD)

    • Crohn's disease and ulcerative colitis are broken down into separate categories, each with distinct characteristics.

    Crohn's Disease

    • Idiopathic, autoimmune condition affecting any portion of the gastrointestinal tract in an irregular (skip) pattern, including the mouth and perianal area.
    • Associated with transmural inflammation (full thickness of bowel), leading to skip lesions, inflammation of the lining of the intestines (mucosa), and possibly abscesses and fistulas.
    • Common to find involvement of the distal ileum and proximal colon in these diseases. Often linked to an increased risk in those with a family or genetic predisposition or those with conditions including autoimmune conditions.
    • Symptoms include abdominal pain (often cramping), diarrhea (with potential bleeding), weight loss, and fatigue. Extraintestinal manifestations like enteropathic arthritis, erythema nodosum and uveitis can occur.
    • Complications include potential flare-ups, obstruction through scarring, abscesses, fistulas, and increased risk of colon cancer.
    • Diagnosis usually involves a combination of patient history, physical examination, stool and blood tests, and possibly an upper endoscopy or colonoscopy.
    • Treatment initially focuses on relieving symptoms and reducing inflammation, potentially involving antidiarrheal medications, anti-inflammatories, corticosteroid treatment, dietary interventions, and possible surgery (removal of affected segments or repair of complications such as strictures).

    Ulcerative Colitis

    • A chronic, autoimmune condition confined to the large colon, commonly beginning in the rectum and sigmoid colon, progressing continuously along the colon.
    • Associated with inflammation in the mucosal layer and potential complications such as bowel incontinence, bleeding, and pain.
    • Common symptoms include recurring diarrhea (often bloody), bowel urgency, and often pain.
    • Potential complications associated with the condition include toxic megacolon (massive colon swelling), severe/massive bleeding, and an increased risk of colon cancer.
    • Diagnosis often requires a combination of patient history, physical examination, stool tests, and frequently, a colonoscopy.
    • Treatment often involves a combination of antidiarrheal agents, anti-inflammatory medications, dietary changes, and possible surgery (colectomy).

    Malabsorption Syndrome

    • Absorption via the small and/or large intestine is impaired.
    • Often a secondary complication of other diseases, most commonly related to damages to the mucous membrane within the gastrointestinal tract.
    • Symptoms related include weight loss, various deficiencies (e.g., calcium, iron, vitamin), and potentially varied signs/symptoms, depending on the specific nutrient/vitamin deficiency resulting from malabsorption.
    • Diagnosis requires a combination of patient history, physical examination, and possibly blood and stool tests to determine specific deficiencies and potential underlying issues.
    • Treatment will depend on the cause, and aim to alleviate symptoms and restore proper nutritional balance.
    • No contraindications for massage. However, consider patient's symptom presence and abdominal sensitivity when planning and executing massage.

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    Digestive Path Lecture 1 PDF

    Description

    This quiz tests your knowledge on Peptic Ulcer Disease (PUD) and hiatal hernias, covering their causes, symptoms, and treatments. Understand common complications and the differences between various types of hernias, while exploring risk factors for GERD. Assess your understanding of these gastrointestinal conditions.

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