Elimination Flashcards
What are 4 common clinical presentations of problems with elimination?
- Acidity
- Transition time (slow/fast)
- Nausea & Vomiting
- Liver disease
Slow transition time = ____ re-absorption of water
increased
Fast transition time = ____ re-absorption of water
decreased
What are gastric pits?
Indented depressions
What cells are gastric pits lined with?
Mucous + specialized gastric cells
What are 2 things gastric juice is composed of?
- HCl
2. pepsinogen
Which cells secrete HCl?
Parietal
Describe how pepsin is formed
- Gastric Chief cells secrete pepsinogen
2. Pepsinogen is activated by HCl into pepsin
What is the function of foveolar cells/ goblet cells
- Protection from gastric juice in esophagus
- Forms mucous and bicarbonate layer (endogenous protection)
How is the lower GI protected from gastric juice?
- Gallbladder secretion of bile
- Pancreatic bicarbonate
What is the function of gastric pits?
- Chemical digestion
- Direct contact w/ gastric capillaries
What is a proton pump’s function?
Releases HCl into stomach
What happens when food is digested in the stomach?
- G cells secrete gastrin
- Gastrin stimulates histamine
- Histamine binds to H2 receptors on parietal cells
- Increases HCl production
What are 2 examples of acidity problems?
- Reflux (& GERD)
2. Peptic Ulcer Disease (PUD)
Describe the 2 conditions that can result in reflux/GERD
- Weak lower esophageal sphincter allows reflux to occur
2. Delayed gastric emptying
What are some beverages that increase of reflux?
- Coffee
- Apple juice
- Carbonated drinks
What are 4 complications of GERD?
- Esophageal erosion
- Pain
- Inflammation
- Decreased appetite
What are 3 treatments for GERD?
- Decrease acidity
- Avoid irritants
- Surgery (fundoplication)
What are 3 causes of PUD?
- H. pylori (g- bacteria)
- NSAIDs
- Stress
What is the pathophysiology of PUD?
- Failure of endogenous protection
- Mucosal erosion
- Can extend into deep layers
____ ulcers have bloody vomit meanwhile ____ ulcers have bloody stool
Gastric, duodenal
How does H. pylori cause a PUD?
H. pylori produces ammonia, which damages the mucosa + neutralizes pH
How do NSAIDs cause PUD?
- Inhibit COX receptors (in charge of mucosa protection)
- Decreased protection of GI mucosa
- Decreased clotting (increases chance of bleeding)
What are 3 options for treating PUD?
- H2 receptor antagonists
- Proton pump inhibitors
- Antacids
How do H2 receptor antagonists decrease acidity?
H2 specific blockade to decrease HCl production
Are H2 receptor antagonists used for acute or chronic treatment?
Acute
What are 3 examples of H2 receptor antagonists?
- Ranitidine (Zantac)
- Cimetidine (Tagamet)
- Famotidine (Pepcid)
How do proton pump inhibitors decrease acidity?
Binds to enzymes on proton pump and prevents HCl secretion
Proton pump inhibitors have ____ efficacy and ____ half lives than H2 receptor antagonists
higher, longer
Are proton pump inhibitors used for acute or chronic treatment?
Chronic
What are 3 examples of proton pump inhibitors?
- Omeprazole (Losec)
- Lansoprazole (Prevacid)
- Pantoprazole (Pantoloc)
How do antacids decrease acidity?
Increase stomach pH
When are antacids used?
For symptom relief only
What are 3 examples of medications based on mineral elements?
- Aluminum hydroxide (Amphojel)
- Magnesium hydroxide (Milk of Magnesia)
- Calcium carbonate (Tums, Caltrate)
A side effect of aluminum is ____ while a side effect of magnesium is ____
constipation, diarrhea
What are 3 malabsorbed nutrients?
- Iron
- Calcium
- Magnesium
1st line therapy for PUD consists of: _ antibiotics + ____
3, PPI
What 3 antibiotics are in the 1st line of therapy for PUD?
- Amoxicillin
- Clarithromycin (if allergy, Tetracycline)
- Metronidazole
Bismuth therapy for PUD consists of: antibiotics + ____ ____
Bismuth subsalicylate (Pepto-bismol)
What is the small intestine responsible for versus the large intestine?
Small: absorption of nutrients
Large: reabsorption of water + vitamin B & K synthesis
Which nervous system innervates the bowel?
ANS, parasympathetic
What do mechanoreceptors do?
Peristalsis/GI stretch
What do chemoreceptors do?
Detect:
- Food presence
- Osmolality
- pH