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NRP511 > deck_10249239 > Flashcards

deck_10249239 Flashcards

1
Q

Achalasia

A

•Esophageal motility disorder (neuromuscular)
•Outflow obstruction d/t inadequate LES relaxation

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2
Q

Achalasia S/S

A

Dysphagia
Heartburn
Chest pain

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3
Q

Achalasia Diagnosis

A

Esophagram reveals “bird’s beak” appearance on EGD manometry

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4
Q

Achalasia Type 1

A

Classic minimal esophageal pressure| Treatment = myotomy

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5
Q

Achalasia Type 2

A

Entire esophagus pressurization| Best outcome

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6
Q

Achalasia Type 3

A

Esophageal spasm w/ premature contractions| Worst outcome

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7
Q

Achalasia Treatment

A 
Palliative Relieve obstruction (does not correct lacking peristalsis)
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8
Q

Distal Esophageal Spasm

A

Diffuse esophageal spasm
Seen in elderly patients
ANS dysfunction

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9
Q

Distal Esophageal Spasm Diagnosis

A

Esophagram reveals “corkscrew” or “rosary bead” esophagus

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10
Q

Distal Esophageal Spasm Treatment

A

Pain mimics angina| Responds to Nitroglycerin

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11
Q

GERD

A

Gastroesophageal reflux disease
LES incompetence

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12
Q

GERD S/S

A

Heartburn
Regurgitation

Less common include dysphagia & chest pain

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13
Q

GERD Complications

A

•Chronic peptic esophagitis
•Strictures
•Barrett’s esophagus
metaplasia associated w/ adenocarcinoma
•Reflux into pharynx, larynx, & tracheobronchial tree
•Apsiration → pulmonary fibrosis or chronic asthma•

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14
Q

GERD Treatment

A

Lifestyle modification:
•avoid foods that impair LES tone (fat, alcohol, peppermint, chocolate) or are acidic

Pharmacological: PPI ↑pH & allows esophagus to heal- H2 antagonists

Surgical: Nissen fundoplication

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15
Q

↑aspiration risk associated w/ ___ mL & ___ pH

A

25mL or 0.4mL/kg| pH <2.5

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16
Q

Esophageal Diverticula

A

Esophageal structural disorder w/ outpouchings
Most common locations: Pharyngoesophageal (Zenker’s diverticulum)- Mid-esophageal- Epi-phrenic (supradiaphragmatic)

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17
Q

Hiatal Hernia

A

Stomach herniates into thoracic cavity via diaphragm esophageal hiatus
Asymptomatic

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18
Q

Esophageal Tumors

A

Progressive dysphagia to solid food & weight loss
Poor survival rate (lymph node metastasis)
Adenocarcinoma
Mortality rate about 50%

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19
Q

Esophageal Tumor Treatment

A

Esophagectomy (curative or palliative)| Thoracic epidural

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20
Q

Esophageal Tumors Complications

A

ARDs
Malnourishment

injury risk

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21
Q

Peptic Ulcer Disease

A

Epigastric pain exacerbated by fasting & improved by eating

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22
Q

H. Pylori

A

Associated w/ PUD| Induces acid secretion via pro-inflammatory cytokines

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23
Q

Gastric Ulcer

A

1/3 duodenal
Benign ulcer
Most common cause = NSAID use

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24
Q

Stress Gastritis

A

Associated w/ shock, sepsis, respiratory failure, burns, hemorrhage, massive transfusions, or head injury
•Gastric bleeding occurs when coagulopathy, thrombocytopenia, INR >1.5, and aPTT >2x normal

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25
Q

Zollinger-Ellison Syndrome

A

•Gastroduodenal & intestinal ulceration d/t increased gastrin secretion
•Non-beta islet cell pancreatic tumor
•Primarily in men 30-50yo
Associated w/ MEN1```

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26
Q

Zollinger-Ellison syndrome (ZES)
S/S

A

Abdominal pain
Peptic ulceration
Diarrhea
GERD

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27
Q

ZES Treatment

A

Obtain fasting gastrin levels
Increasing PPIs dosages
Surgical- tumor resection

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28
Q

PUD Complications

A

•Bleeding- Hemorrhage = leading cause of death
•Perforation(risk 10%)- Severe epigastric pain caused by highly acidic gastric contents in peritoneum
•Obstruction- Gastric outlet obstruction-
Cause = edema & inflammation in the pyloric channel & duodenum 1st portion

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29
Q

PUD Treatment

A

Antacids
H receptor antagonists
Proton pump inhibitors Prostaglandin analogues
Cytoprotective agents
Anticholinergics

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30
Q

Antacids

A

Aluminum hydroxide
Magnesium hydroxide (avoid in chronic renal failure patients → hypermagnesemia & neurotoxicity)
TUMS = calcium carbonate (milk-alkali syndrome hypercalcemia, hyperphosphatemia, & renal calculi)HCO3 → metabolic alkalosis

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31
Q

H2 Receptor Antagonists

A

Cimetidine, Ranitidine, Famotidine, & Nizatidin
•inhibit basal & stimulated gastric acid secretion
•Cimetidine & Ranitidine bind to CYP450

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32
Q

PPIs

A

Proton pump inhibitors

Omaprazole, Pantoprazole, Esomeprazole, Lansoprazole, & Rabeprazole

•They inhibit hydrogen-potassium ATPase pump
The most potent drug available

•Inhibit ALL gastric acid secretion phases

•Interfere w/ Ketoconazole, Ampicillin, Iron, Digoxin, & Diazepam absorption

•Omaprazole & Iansoprazole inhibit CYP450

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33
Q

Prostaglandin Analogues

A

Misoprostol
•Is the onlyFDA approved •Contraindicated in pregnancy
•Enhances mucosal HCO3 secretion, stimulate mucosal blood flow, & ↓mucosal cell turnover
•Most common side effect = diarrhea

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34
Q

Cytoprotective Agents

A

Sucralfate
•provides physiochemical barrier, enhances defense & repair
•Most common side effect = diarrhea
Colloidal bismuth (Pepto) MOA unknown & neurotoxicity risk

35
Q

Anticholinergics

A

•Inhibit muscarinic receptors activation in parietal cells
•Negative side effects
•Not routinely used

36
Q

Post-Gastrectomy| Dumping Syndrome

A

•Hyperosmolar gastric contents enter into proximal small bowel
•Fluid shifts into small bowel lumen
•Results in plasma volume contraction & acute intestinal distention

37
Q

Early Dumping Syndrome

A

Symptoms 15-30min after meal (nausea, epigastric discomfort, diaphoresis, cramps, diarrhea, tachycardia, palpitations, dizziness, syncope)

38
Q

Late Dumping Syndrome

A

Symptoms 1-3hrs after meal| Vasomotor symptoms 2° to hypoglycemia d/t excessive insulin release

39
Q

Dumping Syndrome Treatment

A

•Dietary modifications (fewer simple sugars) & less fluid consumption during meals
•Octreotide therapy - admin SQ before meal or depot injection monthly- Inhibit release vasoactive peptides from gut, ↓peak plasma levels, & slow intestinal transit

40
Q

Post-Gastrectomy| Alkaline Reflux Gastritis

A

Clinical triad:- Post-prandial epigastric pain associated w/ N/V- Evidence bile reflux into stomach- Histologic evidence gastritis
•Treatment-divert intestinal contents from contact w/ gastric mucosa (diversion)

41
Q

Inflammatory Bowel Disease

A

Ulcerative colitis| Crohn’s disease

42
Q

Ulcerative Colitis

A

IBD involves rectum & extends proximally to involve part or all colon
Mucosal disease

43
Q

Ulcerative Colitis s/s

A

•Diarrhea
•rectal bleeding
•tenesmus (feeling incomplete BM)
•passage mucus
•Cramps
•Anorexia
•N/V
•fever
•weight loss
•Low-serum albumin & leukocytosis when severely ill

44
Q

Ulcerative Colitis (UC) Complications

A

•Hemicolectomy when patient requires 6-8 units PRBCs w/in 24-48hrs
•Toxic megacolon - dilated transverse colon w/ loss •hallucinations triggered by electrolyte abnormalities & narcotics
•Perforations → peritonitis
•Obstruction d/t benign stricture formation
•Total proctocolectomy = curative

45
Q

Crohn’s Disease

A

•IBD with acute or chronic bowel inflammation
•Can be Penetrating-fistulous or obstructing pattern
•Most common site = terminal ileum

46
Q

Crohn’s S/S

A

Ileocolitis
•Recurrent episodes RLQ pain & diarrhea and fever indicates intraabdominal abscess formation
•Weight loss d/t anorexia & diarrhea
•Loss of digestive & absorptive surface → megaloblastic anemia & neurologic symptoms
•Hypoalbumenia,
•hypocalcemia, •hypomagnesemia, •coagulopathy,
•hyperoxaluria
•Vit. D deficiency
•hypocalcemia
glucocorticoid use
•B12 malabsorption → megaloblastic anemia & neurologic symptoms
•Diarrhea d/t bacterial overgrowth in obstruction areas, •fistulas,
•bile acid malabsorption,
•DecreasedH2O reabsorption
•1/3 patients at least 1 symptoms outside intestines (arthritis or renal calculi)

47
Q

IBD Surgical Treatment

A

•NOT curative
•Severe IBD → total proctolectomy & end ileostomy
•Most common surgery = small intestine resection
•Removal > 2/3 small intestine → short bowel syndrome & need parenteral nutrition

48
Q

IBD Crohn’s Surgical Complications

A

Hemorrhage
Sepsis
Neural injury

49
Q

IBD Medical Treatment

A

•5-ASA (Mesalamine) to treat mild to moderate IBD-
•Antibacterial & anti-inflammatoryGlucocorticoids moderate to severe Crohn’s only to induce remission & then taper (not maintenance)
•Antibiotics “pouchitis” (Ciprofloxacin & Metronidazole)Azathioprine, Methotrexate, Cyclosporine, & TacrolimusInfliximab & Natalizumab

50
Q

Carcinoid Tumors

A

•Tumors originate in GI tract
1/4 first found in the lung
•Secrete GI peptides/vasoactive substances
•Often found incidentally (suspected appendicitis)
•Sometimes contain GI peptides •Midgut more likely to release substances than foregut carcinoids

51
Q

Carcinoid Syndrome

A

Approximately 10%| Serotonin & vasoactive substances released into systemic circulation

52
Q

Carcinoid Syndrome S/S

A

•Sudden onset flushing & diarrhea
•Flushing d/t histamine (admin H1 & H2 blockers)
•Hypo or hypertension
•Bronchoconstriction
manifestation

53
Q

Carcinoid Syndrome| Precipitating Factors

A

Stress, alcohol, exercise, certain foods, & drugs such as catecholamines, pentagastrin, & SSRIs/SNRIs

54
Q

Carcinoid Syndrome Diagnosis

A

Measure urinary or plasma serotonin
Serotonin metabolites present in urine1° metabolite: 5-HIAA (5-hydroxyindoleacetic acid)

55
Q

Carcinoid Crisis

A

•Intense flushing
•Diarrhea
•Abdominal pain
•Tachycardia
•Hypo or hypertension
Causes include stress, chemo, or biopsy
Avoid using Succinylcholine, Miva/Atracurium, Epi/NE, Dopamine, Isoproterenol, or Thiopental```

56
Q

Carcinoid Tumor Treatment

A

Avoid flushingSerotonin receptor antagonists5HTZ or 5HT3 antagonistsH1/H2 antagonistsSomatostatin analoguesBronchoconstriction resistant to treatment β agonists worsen effects d/t mediator releaseTACE - trans-arterial chemoembolization w/ or w/o chemotherapy

57
Q

Acute Pancreatitis

A

•Pancreas inflammatory disease caused by digestive enzyme
•Autodigestion prevented by enzymes being packaged in precursor form, protease inhibitors synthesis, & low calcium concentrations ↓trypsin activity

58
Q

Acute Pancreatitis| Causes

A

•Gallstones
•ETOH abuse
•Hypercalcemia (hyperparathyroidism & AIDs)
•Post operative pancreatitis after CABG & ERCP

59
Q

Acute Pancreatitis| S/S

A

•Excruciating mid-epigastric pain that radiate to the back
Sitting/leaning forward ↓pain •Abdominal distension w/ ileus
•Dyspnea indicates pleural effusion or ascites
•Low grade fever
•Hypotension& tachycardia
•Shock d/t hypovolemia (blood & plasma exudation into retroperitoneal space, kinins release, & systemic pancreatic enzymes effects)↑serum amylase & lipase
Diagnosis: CT w/ contrast

60
Q

Acute Pancreatitis| Treatment

A

•ERCP (when caused by gallstones)
•Aggressive IVF admin
•Colloid replacement
•NPO to rest pancreas- NJ tube feeding NG tube
•LISStent placement
•Opiods
•extraction
•Sphincterotomy

61
Q

Acute Pancreatitis| Differential Diagnoses

A

•Perforated duodenal ulcer
•Acute cholecystitis
•Mesenteric ischemia
•Bowel obstruction
•Acute MI
•Pneumonia

62
Q

Acute Pancreatitis| Complications

A

•Shock
•hypoxemia
•ARDS
•GI hemorrhage & coagulation •defects
•DIC
•infection or abscess formation

63
Q

Chronic Pancreatitis

A

•Chronic inflammation leads to irreversible damage to pancreas
•Loss of exocrine & endocrine function

64
Q

Chronic Pancreatitis| Causes

A

•Chronic ETOH abuse
w/ high protein diet
•Genetic defects (idiopathic chronic pancreatitis)
•Occurs with CF & hyperparathyroidism

65
Q

Chronic Pancreatitis| Diagnosis

A

•History chronic ETOH abuse + pancreatic calcifications
•Thin or emaciated
•maldigestion proteins & fats
•Normal serum amylase
•U/S reveals enlarged pancreas or pseudocyst
•ERCP most sensitive imaging test

66
Q

Chronic Pancreatitis| S/S

A

•Epigastric pain that radiates to back
•Frequent after eating
•painless steatorrhea
•Diabetes when 90% exocrine fx is lost

67
Q

Chronic Pancreatitis| Treatment

A

•Manage pain, malabsorption, & diabetes
•Opioids
•Celiac plexus blockade
•Pancreatic jejunostomy internal surgical drainage procedure
•Endoscopic stent placement & remove stones
•Enzyme supplements to help fat & protein absorption insulin replacement/therapy

68
Q

Upper GI Bleed

A

Most common
Due to peptic ulcer disease
Mortality >30% elderly, esophageal varices, cancer, & hospitalized patients
#1 cause of death MODS rather than hemorrhage

69
Q

Upper GI Bleed| Diagnosis

A

•Upper endoscopy after hemodynamic stabilization
•Cardiopulmonary concerns d/t blood & gastric content aspiration risk
•Prefer ETT (secured airway

70
Q

Upper GI Bleed| S/S

A

•Hypotension & tachycardia
•Orthostatic hypotension
•Melina stool indicated bleeding ABOVE the cecum
•↑BUN

71
Q

Upper GI Bleed| Treatment

A

•Endoscopic coagulation - perforation risk
•Epi injection
•Endoscopic ligation (bleeding varices)
•Trans-jugular intrahepatic portosystemic shunt (TIPS) esophageal varices resistance to treatment → worsen encephalopathy
•Mechanical balloon tamponade via Blakemore-Sengstaken tube
•Refractory GI bleeding → oversew ulcer or perform gastrectomy

72
Q

Lower GI Bleed

A

Usually from diverticulosis or tumor| Common in older patients

73
Q

Lower GI Bleed| Diagnosis

A

Sigmoidoscopy to exclude anorectal lesions| Colonoscopy

74
Q

Lower GI Bleed| S/S

A

Bright red blood & clots via the rectum

75
Q

Lower GI Bleed| Treatment

A

Angiography embolic therapy| Surgical intervention required about 15%

76
Q

Lower GI Bleed

A

•Usually from diverticulosis or tumor
•Common in older patients

77
Q

Lower GI Bleed| Diagnosis

A

•Sigmoidoscopy to exclude anorectal lesions
•Colonoscopy

78
Q

Lower GI Bleed| S/S

A

Bright red blood & clots via the rectum

79
Q

Lower GI Bleed| Treatment

A

•Angiography embolic therapy
•Surgical intervention required about 15%

80
Q

Adynamic Ileus

A

•Formerly known as acute colonic pseudo-obstruction
•Massive dilation w/o mechanical obstruction
•Loss of effective colonic peristalsis & subsequent colon distention

81
Q

Adynamic Ileus| Causes

A 
Seriously ill hospitalized patients- Electrolyte disorders- Immobile- Narcotic/ anticholinergic medications- Surgical patientsExcessive SNS & lack PSNS input
82
Q

Adynamic Ileus| Diagnosis

A

CXR proximal colon dilation & decompressed distal colon w/ air in rectosigmoid region

83
Q

Adynamic Ileus| Treatment

A

•Correct electrolyte abnormalities
•Avoid narcotics & anticholinergics
•Mobilization tap water enemas
•NG suction
Conservative treatment usually takes 2 days

•Neostigmine IV (monitor bradycardia)
•repetitive colonoscopy, and/or cecostomy placement
If untreated:→ R colon & cecum ischemia

NRP511 (23 decks)

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