Adult GI Flashcards
Meds that effect LES?
TCAs, diazepam, CCB
LA classification for erosive esophagitis Grade A:
One or more mucosal breaks
LA classification for erosive esophagitis Grade B:
One or more breaks greater than 5mm but not continuous
LA classification for erosive esophagitis Grade c:
Mucosal breaks continuous between tops of 2 or more mucosal folds
LA classification for erosive esophagitis Grade D:
Mucosal breaks greater than 75% of the esophageal circumference
GERD management for episodic complaints:
Antacids 1 hour before eating and bed
GERD management of persistent symptoms:
H2 blocker or PPI
Mild- H2 blocker
Severe erosion- PPI
H2 blocker side effects:
GI disturbances, rarely rash, thrombocytopenia, hepatotoxicity, pneumonia
Long term side effects of PPIs:
Vitamin B12, mag, and zinc deficiency
Possible arrhythmias
Possible increased risk of fracture
This is activation of pancreatic enzymes from various processes that results in an auto digestion of the pancreas, starts with inflammation and edema, which leads to necrosis.
Pancreatitis
Pancreatitis mainly caused by:
ETOH or gallstones
Pancreatitis Mnemonic:
G- gallstones E- ethanol T-!trauma S- steroids M- mumps A- autoimmune S- scorpion sting H- hyperlipidemia, hypothermia, hyper parathyroidism E-ERCP D- drugs- steroids, depakote, metformin
Acute pancreatitis symptoms:
Acute abdomen Severe discomfort High pain With or without fever N/V
This is progressive destruction of the pancreas through fibrosis, calcification, and inflammation
Chronic pancreatitis
Diet for chronic pancreatitis:
Low fat, high carbs, high protein
Meds for chronic pancreatitis:
Pancreatic, pancreplipase
Chronic pancreatitis treatment:
Pancreatic enzyme replacement
Management of subsequent conditions
Education
S/s of cirrhosis:
Spider angiomata Palmar erythema Gynecomastia Hypogonadism Hepatomegaly Ascites Fector hepaticus: musty breath Jaundice
Cirrhosis management:
Lifestyle modification- no alcohol, low fat/ unprocessed foods, less than 2 portions of red meat per week
Diuretics and BB
Liver transplant at end stage- alcoholics must have had no alcohol for 1 year
Most common causes of PUD:
NSAIDs
H. Pylori
PUD start by treating on clinical findings unless:
Greater than 40 Early satiety Unintentional weight loss Heme in stool Anemia Could be signs of gastric cancer and endoscopy is urgently needed
Treatment of h pylori induced PUD:
Antibiotics, PPI, and carafate
Time criteria in IBS:
Patients must have abdominal pain at least 3 days/month in last 3 consecutive months with 2 or more of the following sx:
Improvement with defecation
Onset associated with change in frequency of stool
Onset associated with change in appearance of stool
Management of diarrhea predominant IBS:
Stress reduction
Dietary modification
Fiber supplementation
Management for constipation predominant IBS:
Fiber
Osmotic laxative such as MOM or lactulose
Avoid stimulant laxatives
Gold standard for diagnosing IBD?
Colonoscopy
More than 3-4 semisolid stools in a 24 hour period:
Diarrhea
Type of diarrhea caused by either an increase in secretion or decrease in absorption with most common cause of cholera
Secretory
Type of diarrhea that occurs when too much water is secreted into the intestines and is caused by over infection of sugar, salt, celiac disease, laxatives, or lactose intolerance
Osmotic
Type of diarrhea when stool is mixed with blood or pus and is caused by IBD or sever infections
Exudative
Type of diarrhea caused by damage to the mucosal lining which causes passive loss of fluids and is caused by viral, bacterial, parasitic infections, or IBD, Colin cancer
Inflammatory
Treatment of antibiotic associated diarrhea:
Stool culture for c.diff
Metronidazole 500mg PO TID or 250mg PO QID OR oral vancomycin 125 mg QID
This is functional constipation that lasts for over 6 months without any other cause- most common
Primary constipation
Constipation treatment:
Bulk forming agents- bran, psyllium
Stimulant agents
Osmotic laxatives- lactulose, Miralax
This is infection of one of the diverticula with severe colicky LLQ pain.
Diverticulitis
Diverticulitis treatment:
Ciprofloxacin 500mg BID plus metronidazole 500 mg TID 7-10 days
