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NURP 502 - Ex 3 > Adult GI > Flashcards

Adult GI Flashcards

1
Q

What are the 3 major mechanisms responsible for GERD?

A
  1. transient lower esophageal (LES) relaxation
  2. increased abdominal pressure
  3. Low resting sphincter tone
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2
Q

What dietary factors affect GERD?

A
  • smoking
  • caffeine
  • ETOH
  • chocolate
  • peppermint
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3
Q

What medications affect GERD?

A
  • tricyclics
  • antidepressants
  • diazepam
  • CCBs
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4
Q

What is Barrett’s esophagus?

A
  • changes seen in the esophagus after repeated exposure to acid
  • columnar epithelium lined lower esophagus (CELLO)
  • metaplasia, precancerous
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5
Q

What will endoscopy rule out when considering GERD?

A

strictures
Barrett’s
delayed emptying

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6
Q

What are the grades of the Los Angeles Classification System for Erosive Esophagitis?

A
  1. None- no breaks but may have edema, erythema, friability
  2. Grade A- one or more mucosal breaks
  3. Grade B- 1+ breaks >5mm but not continuous
  4. Grade C- breaks continuous between tops of two or more mucosal folds
  5. Grade D- breaks > 75% of esophageal circumference
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7
Q

What is first line for mildly erosive GERD?

A

H2 receptor agonists (cimetidine, famotidine, ranitidine, nizatidine)

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8
Q

What is first line for severe erosive esophagitis?

A

PPI

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9
Q

What are the side effects of long term PPI use (> 12 mo)?

A
  • B12, mag, zinc deficiencies
  • possibly arrhythmias
  • increased risk of fracture
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10
Q

What are the most common causes of pancreatitis

A

80% caused by either ETOH (chronic) or gallstones (acute)

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11
Q

What is the mnemonic for pancreatitis (GET SMASHED)?

A 
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)
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12
Q

What diet should patients with chronic pancreatitis follow?

A
  • low fat (minimizes gallbladder stimulation)
  • high-carb, high-protein (provides increased nutrients in the setting of malabsorption)
  • NO ETOH
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13
Q

What is the patho of cirrhosis?

A

Abnormal blood vessel distribution + fibrosis of vessels = overgrowth of connective tissue

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14
Q

How does ascites form?

A

Build up of fluid in the abdomen that the liver is supposed to process

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15
Q

What are the major causes of cirrhosis?

A
  • ETOH (20 %)
  • Hep B (30 %), Hep C (27 %)
  • Fatty liver disease
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16
Q

What are the s/s of cirrhosis?

A 
telangiectasis, spider angiomata
palmar erythema
gynecomastia
hypogonadism
hepatomegaly
ascites
factor hepaticas (musty breath)
jaundice
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17
Q

What are the major complications of cirrhosis?

A
  • portal HTN
  • varices
  • peripheral edema
  • ascites
  • encephalopathy
  • hepatorenal syndrome
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18
Q

Patho of portal hypertension

A

disregulated blood flow through the liver causes a back up into the portal venous system and any organs that come before the liver

19
Q

Name 4 complications of portal hypertension

A
  1. splenomegaly
  2. esophageal varices
  3. coagulation changes
  4. encephalopathy
20
Q

Define asterixis.

A

flapping of the hands caused by increased ammonia

21
Q

What dietary modifications are recommended with cirrhosis?

A
  • low fat (decrease gallbladder stimulation)
  • NO ETOH
  • less than 2 portions of red meat per week
22
Q

What medications should be used in cirrhosis?

A
  • diuretics

- BBs (protect heart)

23
Q

Why do NSAIDs cause PUD?

A

they inhibit gastric mucosal prostaglandin synthesis and have a direct erosive effect

24
Q

What is the difference in the onset of pain with gastric vs duodenal ulcers?

A
  • gastric = pain with food intake

- duodenal = pain relieved with food intake

25
Q

What red flags indicate further w/u of PUD before initiating treatment?

A
  • over 40 yo
  • early satiety
  • unintentional weight loss
  • blood in stool
  • anemia
26
Q

Name the 3 meds used to treat PUD.

A
  1. antibiotics
  2. PPI
  3. carafate
27
Q

What is the ROME criteria for diagnosing IBS?

A

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
28
Q

Define diarrhea

A

> 3-4 semisolid stools in a 24 hour period

29
Q

What is the recipe for ORS

A

8oz of water with 1 tsp of salt and 1 tsp of sugar

30
Q

Define constipation

A
  • less than 3 BMs a week
  • difficulty or pain with defecation
  • sensation of incomplete defecation
31
Q

What is the treatment for diverticulitis?

A

Cipro 500 mg BID and metronidazole 500 mg TID for 7-10 days

32
Q

What non-pharm treatments are recommended for CVS?

A
  • keep a journal of precipitating factors
  • provide supplemental carbs for fasting or high-energy events
  • maintain healthy lifestyle
33
Q

What drugs are used in CVS? (<5>)

A

<5 yo: cryoheptadine
> 5yo: amitriptyline
(propanolol is 2nd choice for any age)

34
Q

Name the differences between primary and secondary ulcers in PUD?

A

Primary: duodenal, no underlying cause, chronic, more common in adolescents than children
Secondary: gastric, acute, associated with pro ulcerative events

35
Q

What are the main causes of secondary ulcers?

A

NSAIDS, head trauma, severe burns, corticosteroids

36
Q

What is the role of ASA and NSAIDS in ulcer formation?

A

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

37
Q

What are the protective factors associated with PUD?

A

water-insoluble mucous gel lining
local production of bicarb
regulation of gastric acid
adequate mucosal blood flow

38
Q

What are the aggressive factors associated with PUD?

A

acid pepcid environment
H. pylori
mucosal ischemia

39
Q

Describe abdominal wall pain, visceral pain, and parietal pain.

A

Abd wall: constant, achy
Visceral: from distention or spasm of hollow organ, cramps, dull
Parietal: from an organ (pancreas/gall bladder), sharp, well localized

40
Q

What is Rovsing’s sign?

A

Pain in the RLQ with palpation of the LLQ

41
Q

What is the Oburator sign?

A

Abd pain with passive rotation of the flexed hip and knee of the right leg

42
Q

What is psoas sign?

A

Abd pain when patient raises straightened right leg against resistance

43
Q

What is the Charcot triad in relation to cholelithiasis?

A

RUQ pain, fever, and jaundice

44
Q

What is a MELD score?

A

Prediction tool for prioritizing liver transplant candidates.
-Na, serum creatinine, bilirubin, and INR

NURP 502 - Ex 3 (5 decks)

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