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N216 A/B > Elimination > Flashcards

Elimination Flashcards

1
Q

What are 4 common clinical presentations of problems with elimination?

A
  1. Acidity
  2. Transition time (slow/fast)
  3. Nausea & Vomiting
  4. Liver disease
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2
Q

Slow transition time = ____ re-absorption of water

A

increased

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3
Q

Fast transition time = ____ re-absorption of water

A

decreased

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4
Q

What are gastric pits?

A

Indented depressions

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5
Q

What cells are gastric pits lined with?

A

Mucous + specialized gastric cells

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6
Q

What are 2 things gastric juice is composed of?

A
  1. HCl

2. pepsinogen

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7
Q

Which cells secrete HCl?

A

Parietal

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8
Q

Describe how pepsin is formed

A
  1. Gastric Chief cells secrete pepsinogen

2. Pepsinogen is activated by HCl into pepsin

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9
Q

What is the function of foveolar cells/ goblet cells

A
  • Protection from gastric juice in esophagus

- Forms mucous and bicarbonate layer (endogenous protection)

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10
Q

How is the lower GI protected from gastric juice?

A
  • Gallbladder secretion of bile

- Pancreatic bicarbonate

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11
Q

What is the function of gastric pits?

A
  • Chemical digestion

- Direct contact w/ gastric capillaries

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12
Q

What is a proton pump’s function?

A

Releases HCl into stomach

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13
Q

What happens when food is digested in the stomach?

A
  1. G cells secrete gastrin
  2. Gastrin stimulates histamine
  3. Histamine binds to H2 receptors on parietal cells
  4. Increases HCl production
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14
Q

What are 2 examples of acidity problems?

A
  1. Reflux (& GERD)

2. Peptic Ulcer Disease (PUD)

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15
Q

Describe the 2 conditions that can result in reflux/GERD

A
  1. Weak lower esophageal sphincter allows reflux to occur

2. Delayed gastric emptying

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16
Q

What are some beverages that increase of reflux?

A
  • Coffee
  • Apple juice
  • Carbonated drinks
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17
Q

What are 4 complications of GERD?

A
  • Esophageal erosion
  • Pain
  • Inflammation
  • Decreased appetite
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18
Q

What are 3 treatments for GERD?

A
  1. Decrease acidity
  2. Avoid irritants
  3. Surgery (fundoplication)
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19
Q

What are 3 causes of PUD?

A
  1. H. pylori (g- bacteria)
  2. NSAIDs
  3. Stress
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20
Q

What is the pathophysiology of PUD?

A
  • Failure of endogenous protection
  • Mucosal erosion
  • Can extend into deep layers
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21
Q

____ ulcers have bloody vomit meanwhile ____ ulcers have bloody stool

A

Gastric, duodenal

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22
Q

How does H. pylori cause a PUD?

A

H. pylori produces ammonia, which damages the mucosa + neutralizes pH

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23
Q

How do NSAIDs cause PUD?

A
  • Inhibit COX receptors (in charge of mucosa protection)
  • Decreased protection of GI mucosa
  • Decreased clotting (increases chance of bleeding)
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24
Q

What are 3 options for treating PUD?

A
  1. H2 receptor antagonists
  2. Proton pump inhibitors
  3. Antacids
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25
Q

How do H2 receptor antagonists decrease acidity?

A

H2 specific blockade to decrease HCl production

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26
Q

Are H2 receptor antagonists used for acute or chronic treatment?

A

Acute

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27
Q

What are 3 examples of H2 receptor antagonists?

A
  1. Ranitidine (Zantac)
  2. Cimetidine (Tagamet)
  3. Famotidine (Pepcid)
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28
Q

How do proton pump inhibitors decrease acidity?

A

Binds to enzymes on proton pump and prevents HCl secretion

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29
Q

Proton pump inhibitors have ____ efficacy and ____ half lives than H2 receptor antagonists

A

higher, longer

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30
Q

Are proton pump inhibitors used for acute or chronic treatment?

A

Chronic

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31
Q

What are 3 examples of proton pump inhibitors?

A
  1. Omeprazole (Losec)
  2. Lansoprazole (Prevacid)
  3. Pantoprazole (Pantoloc)
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32
Q

How do antacids decrease acidity?

A

Increase stomach pH

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33
Q

When are antacids used?

A

For symptom relief only

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34
Q

What are 3 examples of medications based on mineral elements?

A
  1. Aluminum hydroxide (Amphojel)
  2. Magnesium hydroxide (Milk of Magnesia)
  3. Calcium carbonate (Tums, Caltrate)
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35
Q

A side effect of aluminum is ____ while a side effect of magnesium is ____

A

constipation, diarrhea

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36
Q

What are 3 malabsorbed nutrients?

A
  1. Iron
  2. Calcium
  3. Magnesium
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37
Q

1st line therapy for PUD consists of: _ antibiotics + ____

A

3, PPI

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38
Q

What 3 antibiotics are in the 1st line of therapy for PUD?

A
  1. Amoxicillin
  2. Clarithromycin (if allergy, Tetracycline)
  3. Metronidazole
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39
Q

Bismuth therapy for PUD consists of: antibiotics + ____ ____

A

Bismuth subsalicylate (Pepto-bismol)

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40
Q

What is the small intestine responsible for versus the large intestine?

A

Small: absorption of nutrients
Large: reabsorption of water + vitamin B & K synthesis

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41
Q

Which nervous system innervates the bowel?

A

ANS, parasympathetic

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42
Q

What do mechanoreceptors do?

A

Peristalsis/GI stretch

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43
Q

What do chemoreceptors do?

A

Detect:

  • Food presence
  • Osmolality
  • pH
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44
Q

Diarrhea occurs when the transition time is too ____

45
Q

What are 4 common causes of diarrhea?

A
  1. Infectious organisms
  2. Food intolerances
  3. Intestinal disease
  4. Drugs
46
Q

Acute diarrhea is less than _ weeks and can either be ____ or ____

A

2, inflammatory, noninflammatory

47
Q

What are 3 complications of diarrhea?

A
  1. Electrolyte imbalance
  2. Dehydration
  3. Malabsorption
48
Q

Describe inflammatory diarrhea

A
  • Infectious
  • Pathogenic (invades mucosa)
  • Fever + bloody stool (dysentery)
  • LLQ cramps, urgency + tenesmus
49
Q

Describe noninflammatory diarrhea

A
  • Usually not infectious
  • Effect mediated by toxins
  • Watery stool
  • N&V, bloating, periumbilical cramps
50
Q

How do you treat Traveler’s Diarrhea?

A
  1. Treat infection first [Ciprofloxacin (PO, IV)]

2. Manage diarrhea symptoms

51
Q

C. difficile is gram ____ and produces 2 toxins: ____ & ____

A

positive, enterotoxin, cytotoxin

52
Q

What are the 4 signs and symptoms of a C. difficile infection?

A
  1. Severe diarrhea
  2. Blood or pus in stool
  3. Fever
  4. Abdominal pain
53
Q

What are 2 causes of a C. difficile infection?

A
  1. Nosocomial

2. Long term antibiotic treatment

54
Q

1st line of treatment for C. difficile infection: ____

2nd line of treatment for C. difficile infection: ____

A

Flagyl (PO)

Vancomycin (PO)

55
Q

What are probiotics?

A

Live “good” bacteria

56
Q

What is an example of a probiotic?

A

Lactobacillus acidophilus

57
Q

Probiotics ____ + ____ normal flora

A

restore, protect

58
Q

Chronic diarrhea is longer than _ weeks and can be ____, ____ or ____

A

4, osmotic, secretory, inflammatory

59
Q

What causes osmotic diarrhea?

A

Too much solute stays in the intestine and water can’t be reabsorbed completely due to the hyperosmotic environment
ie) lactose intolerance

60
Q

What are the 2 causes of secretory diarrhea?

A
  1. Body secretes too many electrolytes and causes water build up
  2. Too much bile acid in the colon, which causes secretion
61
Q

What 5 chronic GI diseases are associated with chronic diarrhea?

A
  1. IBD
  2. IBS
  3. Malabsorption syndrome
  4. Endocrine disorders
  5. Radiation colitis
62
Q

What are the 4 signs and symptoms of IBS being the cause of diarrhea?

A
  1. Abdominal pain
  2. Cramping
  3. Bloating
  4. Diarrhea/constipation
63
Q

What are 4 potential triggers for IBS?

A
  1. Stress
  2. Menstruation
  3. Diet
  4. Food intolerances
64
Q

What is the pathophysiology of IBS?

A

CNS dysregulation of normal motility

65
Q

Opioids are the ____ effective treatment for diarrhea because they bind to __ receptors in the GI, which ____ peristalsis

A

most, Mu2, decrease

66
Q

What are 2 side effects of opioids as antidiarrheals?

A
  1. CNS depression

2. Constipation

67
Q

What are 2 cautions of using opioids as antidiarrheal?

A
  1. Pregnant women

2. Addiction

68
Q

Atropines ____ parasympathetic system and ____ sympathetic system

A

block, stimulate

69
Q

What are 2 examples of opioid + atropine medications?

A
  1. Lomotil (dyphenoxylate)

2. Imodium (loperamide HCl)

70
Q

How do antidiarrheals work? (3 ways)

A
  1. Decreases peristalsis
  2. More fluid absorption
  3. Stool is more solid
71
Q

How do we rehydrate a patient in the hospital vs at home?

A

Hospital: isotonic IV solution
Home: gastrolyte, pedialyte

72
Q

Constipation occurs when transition time is too ____

73
Q

What are 3 common causes of constipation?

A
  1. Insufficient water and/or fibre intake
  2. Alterations in peristalsis
  3. Alterations in intestinal innervation
74
Q

Describe Hirschsprung disease

A

Parasympathetic ganglion cells in the wall of large intestine don’t develop before birth (poop is stuck)

75
Q

What are the 5 types of laxatives?

A
  1. Bulk forming
  2. Softners
  3. Saline & Osmotic
  4. Stimulants
  5. Lubricating
76
Q

How do bulk forming laxatives work?

A

Pulls water into stool, increasing size

77
Q

What is an example of a bulk forming laxative?

A

Metamucil (psyllium)

78
Q

Describe metamucil

A
  • Fibre powder
  • Water intake is a must
  • Prophylactic
79
Q

How do softener laxatives work?

A

Pulls water + fat into stool

80
Q

Describe softener laxatives

A
  • PO
  • Requires good renal function
  • Used post MI or surgery
  • Takes 1-3 days
81
Q

What is an example of a softener laxative?

A

Colace (docusate sodium)

82
Q

How do saline and osmotic laxatives work?

A

Pulls water into stool

83
Q

What are 2 examples of saline and osmotic laxatives?

A
  1. Milk of magnesia

2. Lactulose

84
Q

Describe saline and osmotic laxatives

A
  • Pre-procedural is best
  • Acts fast
  • Potent
  • Not systemic
85
Q

How do stimulants/irritants work?

A

Increases peristalsis

86
Q

What are 2 side effects of irritants?

A
  1. N&V

2. Cramping

87
Q

What are 3 examples of irritants?

A
  1. Dulcolax
  2. Senna (Exlax, Senokot)
  3. Castor oil
88
Q

What are the 3 conditions when you shouldn’t use stimulants/irritants?

A
  1. Perforation
  2. First choice for constipation
  3. Pre-surgery
89
Q

What are 2 examples of lubricating laxatives?

A
  1. Mineral oil

2. Glycerine (PR)

90
Q

What are cathartics?

A

Pre-procedure (bowel surgery or colonoscopy) preparation
> Expands bowel
> Clears contents

91
Q

How to treat bloating?

A

Enzymes to increase carbohydrate digestion

ie) Gasex

92
Q

How does the vomiting centre in the medulla work?

A
  • Outside the BBB
  • Receives sensory pathway signals OR senses toxins
  • Triggers stomach contractions
93
Q

What 5 receptors are involved in the N&V response?

A
  1. D2 = dopamine
  2. 5HT = serotonin
  3. H1 = histamine
  4. M = muscarinic
  5. CB1 = cannabinoid
94
Q

What are the 3 steps in treating N&V?

A 
1. Treat the N&V
> Target receptors
2. Treat underlying cause
> ie) pain, poisoning
3. Treat the effects of N&V
> ie) dehydration, electrolyte imbalances
95
Q

What are 3 examples of H1 antagonists/antihistamines?

A
  1. Dimenhydrinate (Gravol)
  2. Meclizine (Dramamine)
  3. Dilectin*
    * For pregnant
96
Q

What do H1 antagonists do to counter motion sickness?

A

Reduce vestibular excitation

97
Q

What does ginger gravol do to combat nausea?

A

Increases intestinal peristalsis

98
Q

What is an example of an antimuscarinic anticholinergic?

A

Scopolamine (Hycosine)*

*Transderm. patch, IV + PO

99
Q

What do antimuscarinic anticholinergics do to combat nausea?

A

Reduce vestibular excitation

100
Q

What are 2 uses of 5HT3 (serotonin) antagonists?

A
  1. Drug-induced & chemotherapy treatment

2. Visceral pain

101
Q

What is an example of a 5HT3 (serotonin) antagonist?

A

Ondansetron (Zofran)*

*PO, IV

102
Q

What are D2 receptor antagonists used for?

103
Q

How do D2 receptor antagonists counter GI pain?

A

Stimulate GI motility

104
Q

What is are 2 examples of a D2 receptor antagonist?

A

Phenothiazines:

  1. Metoclopramide (Maxeran, reglan)
  2. Prochlorperazine (Stemetil)
105
Q

What is a side effect of phenothiazines?

106
Q

What are the 3 uses for CB1 & 2 agonism?

A
  1. Chemotherapy
  2. Chronic disease
  3. Challenging cases
107
Q

What are 3 examples of CB 1 & 2 agonists?

A

Cannabinoids:

  1. Dronabinol (Marinol)
  2. Cesamet/Nabilone
  3. Cannabis
108
Q

Cannabinoids’ receptor binding ____ GABA and ____ sympathetic activity

A

stimulates, inhibits

109
Q

What are the 2 active ingredients in cannabinoids?

A
  1. THC

2. CBD

N216 A/B (26 decks)

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