Adult GI Flashcards
What are the 3 major mechanisms responsible for GERD?
- transient lower esophageal (LES) relaxation
- increased abdominal pressure
- Low resting sphincter tone
What dietary factors affect GERD?
- smoking
- caffeine
- ETOH
- chocolate
- peppermint
What medications affect GERD?
- tricyclics
- antidepressants
- diazepam
- CCBs
What is Barrett’s esophagus?
- changes seen in the esophagus after repeated exposure to acid
- columnar epithelium lined lower esophagus (CELLO)
- metaplasia, precancerous
What will endoscopy rule out when considering GERD?
strictures
Barrett’s
delayed emptying
What are the grades of the Los Angeles Classification System for Erosive Esophagitis?
- None- no breaks but may have edema, erythema, friability
- Grade A- one or more mucosal breaks
- Grade B- 1+ breaks >5mm but not continuous
- Grade C- breaks continuous between tops of two or more mucosal folds
- Grade D- breaks > 75% of esophageal circumference
What is first line for mildly erosive GERD?
H2 receptor agonists (cimetidine, famotidine, ranitidine, nizatidine)
What is first line for severe erosive esophagitis?
PPI
What are the side effects of long term PPI use (> 12 mo)?
- B12, mag, zinc deficiencies
- possibly arrhythmias
- increased risk of fracture
What are the most common causes of pancreatitis
80% caused by either ETOH (chronic) or gallstones (acute)
What is the mnemonic for pancreatitis (GET SMASHED)?
G- gallstones E- ethanol T- trauma S- steroids M- mumps A- autoimmune S- scorpion sting H- hyper lipids, hypothermia, hyperparathyroid E- ERCP D- drugs (steroids, depakote, metformin)
What diet should patients with chronic pancreatitis follow?
- low fat (minimizes gallbladder stimulation)
- high-carb, high-protein (provides increased nutrients in the setting of malabsorption)
- NO ETOH
What is the patho of cirrhosis?
Abnormal blood vessel distribution + fibrosis of vessels = overgrowth of connective tissue
How does ascites form?
Build up of fluid in the abdomen that the liver is supposed to process
What are the major causes of cirrhosis?
- ETOH (20 %)
- Hep B (30 %), Hep C (27 %)
- Fatty liver disease
What are the s/s of cirrhosis?
telangiectasis, spider angiomata palmar erythema gynecomastia hypogonadism hepatomegaly ascites factor hepaticas (musty breath) jaundice
What are the major complications of cirrhosis?
- portal HTN
- varices
- peripheral edema
- ascites
- encephalopathy
- hepatorenal syndrome
Patho of portal hypertension
disregulated blood flow through the liver causes a back up into the portal venous system and any organs that come before the liver
Name 4 complications of portal hypertension
- splenomegaly
- esophageal varices
- coagulation changes
- encephalopathy
Define asterixis.
flapping of the hands caused by increased ammonia
What dietary modifications are recommended with cirrhosis?
- low fat (decrease gallbladder stimulation)
- NO ETOH
- less than 2 portions of red meat per week
What medications should be used in cirrhosis?
- diuretics
- BBs (protect heart)
Why do NSAIDs cause PUD?
they inhibit gastric mucosal prostaglandin synthesis and have a direct erosive effect
What is the difference in the onset of pain with gastric vs duodenal ulcers?
- gastric = pain with food intake
- duodenal = pain relieved with food intake
What red flags indicate further w/u of PUD before initiating treatment?
- over 40 yo
- early satiety
- unintentional weight loss
- blood in stool
- anemia
Name the 3 meds used to treat PUD.
- antibiotics
- PPI
- carafate
What is the ROME criteria for diagnosing IBS?
Patients must have and pain/discomfort at least 3 days/mo in last consecutive 3 mo with 2 + of the following:
- improvement of pain with defecation
- onset associated with change in frequency of stooling
- onset associated with change in appearance of stool
Define diarrhea
> 3-4 semisolid stools in a 24 hour period
What is the recipe for ORS
8oz of water with 1 tsp of salt and 1 tsp of sugar
Define constipation
- less than 3 BMs a week
- difficulty or pain with defecation
- sensation of incomplete defecation
What is the treatment for diverticulitis?
Cipro 500 mg BID and metronidazole 500 mg TID for 7-10 days
What non-pharm treatments are recommended for CVS?
- keep a journal of precipitating factors
- provide supplemental carbs for fasting or high-energy events
- maintain healthy lifestyle
What drugs are used in CVS? (<5>)
<5 yo: cryoheptadine
> 5yo: amitriptyline
(propanolol is 2nd choice for any age)
Name the differences between primary and secondary ulcers in PUD?
Primary: duodenal, no underlying cause, chronic, more common in adolescents than children
Secondary: gastric, acute, associated with pro ulcerative events
What are the main causes of secondary ulcers?
NSAIDS, head trauma, severe burns, corticosteroids
What is the role of ASA and NSAIDS in ulcer formation?
they cause ulcer formation by direct injury or inhibition of cyclooxegenase and prostaglandin formation.
-chronic use is associated with mucosal damage but NOT ulcer formation
What are the protective factors associated with PUD?
water-insoluble mucous gel lining
local production of bicarb
regulation of gastric acid
adequate mucosal blood flow
What are the aggressive factors associated with PUD?
acid pepcid environment
H. pylori
mucosal ischemia
Describe abdominal wall pain, visceral pain, and parietal pain.
Abd wall: constant, achy
Visceral: from distention or spasm of hollow organ, cramps, dull
Parietal: from an organ (pancreas/gall bladder), sharp, well localized
What is Rovsing’s sign?
Pain in the RLQ with palpation of the LLQ
What is the Oburator sign?
Abd pain with passive rotation of the flexed hip and knee of the right leg
What is psoas sign?
Abd pain when patient raises straightened right leg against resistance
What is the Charcot triad in relation to cholelithiasis?
RUQ pain, fever, and jaundice
What is a MELD score?
Prediction tool for prioritizing liver transplant candidates.
-Na, serum creatinine, bilirubin, and INR
