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Esophagus Flashcards

1
Q

Oesophageal vasculature

Arterial in oesophagus

Oesophageal arteries of the aorta
Inferior thyroid arteries
Left gastric artery

GEJ
Left gastric artery
Inferior phrenic arteries

What are the venous?

A

Azygos vein
Thyroid vein
Left gastric vein

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2
Q

Bile is a combination of what?

A 
Water
Bile acids
Bile pigments
Cholesterol
Bilirubin
Phospholipids
Potassium
Sodium
Chloride
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3
Q

What is the main bile pigment?

A

Bilirubin

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4
Q

Carbohydrates converting glucose, fructose and galactose to glycogen (glucogenesis) for storage in the liver

Breaking down glycogen to glucose(glycogenolysis) to maintain blood glucose levels when there is insufficient intake of carbohydrates

Synthesising glucose from noncarbohydrate nutrients (gluconeogenesi) to maintain blood glucose levels

True or false

A

True

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5
Q

What does liver cellas do in amino acids?

A

Deamination converts nitrogen from the amino acid into ammonia, which is converted by the liver into urea and is excreted in the urine.

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6
Q

Digested fat is converted in the intestine to triglycerides, cholesterol, phospholipids and lipoproteins.

This substances are then taken up by the liver and hydrolyzed to glycerol and fatty acids through a process known as what?

A

Ketogenesis

Liver also metabolizes adrenocortical steroids, glucocorticoids, estrogens, testosterones, progesterones and aldosterones

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7
Q

Coagulation factors should continue to be monitored especially prior to procedures or symptoms of clinical bleeding.

Correction of coagulopathy should not be undertaken routinely why?

A

It may complicate the determination of diagnosis.

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8
Q

What is fector hepaticus?

A

Sweet, fetid breath odour

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9
Q

Sx of portal hypertension

A

Melena
Hematemesis
Bleeding tendencies
Fector hepaticus

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10
Q

Physical findings for portal hypertension includes

A 
Splenomegaly
Varices
Caput medusae
Jaundice
Peripheral oedema
Palmar erythema
Spider nevi
Dilated veins in the anterior abdominal wall
Venous pattern on the flanks

There may be confusion, lethargy, inc in irritability altered sleep patterns

Sx due to inc estrogen levels includes altered hair distribution, gynecomastia in men, testicular atrophy, menstrual disorder

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11
Q

How to measure portal vein pressure gradient (PVPG) in portal hypertension?

A

Measure pirtal pressure and pressure in inferior vena cava

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12
Q

As portal hypertension develops, Splanchnic arterial vasodilation occurs what happens next?

A

It affects arterial blood volume and causes homeostasis activation of vasoconstrictor and antinatriuretic factors that leads to sodium retention, renal function abnormalities and splanchnic capillary pressure changes that cause a fluid shift to the abdominal cavity as a result of ASCITES

Ascites may be controlled by low salt diet and diuretics

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13
Q

What is the most cause of ascites?

A

Portal hypertension accounts for 80 % of occurrences.

Other causes are cancer, cardiac ascites with a hx of heart failure, acute hemorrhage pancreatitis or rupture pancreatic duct in chronic pancreatitis and trauma

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14
Q

What peritoneovenous (leveen) shunt and why is it rarely used?

A

Divert ascitic fluid from abdominal cavity into the superior vena cava. It is uncommon and reserved for a selected group due to its long term and many complications and may impact transplantation success.

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15
Q

When is paracentecis done?

A

To relieve respiratory and abdominal distress or for diagnostic purposes

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16
Q

What is Hepatorenal syndrome?

A

Progressive and functional renal failure with severe liver dse without clinical or anatomical evidence or causes to explain the persistence of renal failure.

It is caused by decreased and unstable renal perfusion to the kidneys.

Characterestics are azotemia < normal urine volume, concentrated urine, sodium concentration less than 10 meq/L. Hyponatremia, hyperkalemia,hepatic encephalopathy and coma.

Mx includes high calorie intake, low sodium and low protein
A trial of fluid challenge using saline with salt poor albumin or plasma to increase the effective plasma volume
Dialysis may be helpful in patients with reversible forms of liver dse

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17
Q

What is ammonia?

A

It is normally produced by the breakdown of protein in the bowel and in healthy individuals, it is metabolised in the liver to form urea

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18
Q

What is asterixis?

A

Rapid wrist flapping or liver flap

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19
Q

Treatment for hepato encephalopathy

A

Correcting ph and electrolytes, restricting dietary protein, removing excess protein from the gut, preventing constipation and GI bleeding because the breakdown of blood results in ammonia production.

Neomycin sulfate, metronidazole or rifaximin decrease the number of bacteria that breakdown amino acids.

Lactulose acidifies the environment of the bowel which changes ammonia into ammonium making it less readily absorbed.

Hypokalemia should be corrected as it increases renal ammonia production

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20
Q

Atropine is use for what?

A

To prevent vasovagal reactions, bradycardia, reduce bowel motility and secretion. Use as premedication for endoscopic procedures

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21
Q

Urecholine (bethanicol CI) is use for what?

A

Stimulates gastric motility and relieves urinary retention, restore impaired peristalsis

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22
Q

Tensilon (edtophonium) is used for what?

A

Used as provocative test of oesophageal motility disorders that present as chest pain

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23
Q

Amoxicillin, Ampicillin, Nafcillin (penicillin)

A

Antibiotic prophylaxis, salmonella infections, shigellosis, H. Pylori, diverticulitis

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24
Q

Biaxin (claritromicin)

A

H. Pylori tx combined with lansoprazole and amoxicillin

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25
Q

Flagyl (metronidazole)

A

Prophylaxis used for patients allergic to penicillin

Giardiasis

Crohn’s pseudomembranous colitis, eradication of H. Pylori, aspiration pneumonia, intraabdominal infections, amebiasis, prevention of infection during and after surgery

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26
Q

Piptaz

A

Prophylaxis for duodenal and colorectal surgery

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27
Q

Metopenem

A

Certain serious intra-abdominal infections. ICU patients with severe diverticulitis

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28
Q

Ciprofloxacin (fluoroquinolones)

A

Hospitalized patients with mild to moderate diverticulitis

ICU patients with severe diverticulitis

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29
Q

Levbid, levsinex, nulev (Hyoscyamine sulfate)

A

Tx for GI spasms and hypermotility, conjunct yherapy for peptic ulcer dse, IBS, diverticulitis, colitis or pain, hypersecretion pancreatitis

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30
Q

Pepto-bismol (bismuth subsalicylate)

A

Diarrhea, heartburn, indigestion, upset stomach, nausea

Contraindication for patients allergic to aspirin or salicylates

May cause darkening of stool and tongue discoloration

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31
Q

Lomotil (diphenoxylate HCL attopine sulfate opiate and opiod derivatives)

A

Diarrhea

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32
Q

Imodium (loperamide HCL opiate opiod derivatives)

A

Acute, non specific diarrhea and chronic diarrhea associated with IBS, chronic traveler’s diarrhea

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33
Q

Cholestyramine

A

Bile acid induced diarrhea

Less frequent Adverse effects
Abdo discomfort, vit A, D K def,bleeding, steatorrhea, heartburn, diarrhea, n/v,

Most common constipation

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34
Q

Thorazine (Chlorpromazine HCL)

A

N/v, control of hiccups

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35
Q

Dramamine (dimenhydrinate)

A

Tx of motion sickness

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36
Q

Reglan (metoclopramide)

A

Prevent chemo n/v

Prevent post op n/v

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37
Q

Compazine (prochlorperazine)

A

Severe N/V

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38
Q

Tigan (trimethobenzamide)

A

N/V in gastroenteritis, post op N/V

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39
Q

Zofran (ondansetton HCL)

A

N/V drugs from 5 HT3 antagonists. Acute emesis but only a minor role in delayed N/V

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40
Q

Inapsine (droperidil)

A

Premed for surgery of diagnostic procedure

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41
Q

Mylicon gasx beano (simethicone)

A

Relief of painful symptome of excess gas in GIT

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42
Q

Pepcid oral suspension, chewable tablets/gel/caps (famotidine)

A

ZES agents, oesophagitis, GERD, duodenal ulcer. H. Pylori tx regiment

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43
Q

Tagamet (cimetidine)

A

GERD, heartburn

Duodenal ulcer (DU)
GU, PU
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44
Q

Zantac (Ranitidine HCL)

A

PU dse,
Duodenal Ulcer
ZES agent

Adverse effects
Blood count changes, arthralgia, arrythmias

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45
Q

Carafate (Sucralfate)

1g po qid 1 ac or 2 hr pc

A

Short term tx of Duodenal Ulcer

Adverse effects
Must separate concurrent drugs by at least 3 hrs

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46
Q

Cytotec (misoprolol)

200mcg po qid with food

A

Prevention of NSAIDS induced ulcers

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47
Q

Prilosec (omeprazole)
20 mg >20 kg for GERD/erosive oesophagitis
20 mg qd
10 mg qd <20 kg

A

Erosive oesophagitis, heartburn, GERD

Short term tx of active benign gastric ulcers, DU ZES

48
Q 
Protonix x (pantoorazolr sodium)
7-10 days IV inf for GERD 40 mg qd

IV 80 mg q12h adjust based on acid output max 240 mg/day

A

GERD, erosive oesophagitis, ZES

49
Q

Aciphex (rabeprazole)

A

Heartburn, GERD

Suspected onown H. Pylori related to PU/DU

50
Q

Hydrocortisone (anti inflammatory)

A

UC/Crohn’s

Adverse effects
Cushingoid changes, fluid & electrolyte disturbances, osteoporosis, pancreatitis, growth suppression, diabetes, GU, glaucoma

51
Q

Entocort EC (budesonide)

A

Mild to mod active crohn’s involving ileum and ascending

52
Q

Prednisone

A

Mod to severe crohn’s dse

53
Q

Medrol (Methylprednisolone)

A

UC/Crohn’s, shock, severe lupus nephritis ascites, spinal cord injurypneumocystic carinii pneumonia

54
Q

Kenalog (triamcinolone acetonide) not for IV ise. 1 mg intralesional use only
Use in each quadrant of the narrowest region of the stricture

A

Dysphagia in patients with benign oesophageal strictures, oedematous state, collagen

Adverse effects
Monitor cardiac status during endoscopic procedure
Myopathy, depression, anorexia with weight loss, sedation

55
Q

Actigall (ursodiol) clfor chronic cholestasis

A

Dissolution of radiolucent cholesterol stone less than 20 mm in diameter

56
Q

Glucagon 0.2-0.4 mg IV

A

Inhibit GI motility esp inconjunction with ERCP

Adverse
N/V

57
Q

Pentagastrin

A

Stimulates gastric acid secretion

Adverse
Flushing lightheadedness abdo discom, N

58
Q

Secretin 2 units/kg over 1 min

A

Stimulates pancreatic exocrine, diagnosis of gastrinoma

59
Q

Gallbladder therapeutic agents

Chenodiol

A

Dissolution of radiolucent cholesterol stones

Adverse
Reversible elevated hepatic enzymes, cramps, heartburn, diarrhea

60
Q

Docusate sodium/sennosides 2-4 tabs qd

A

Constipation

61
Q

Lactulose 15-30 mls po/day- constipation
30-45mls tid/qid for portal systemic enteropathy
Or as a retention to reverse hepatic coma

A

Constipation, portal systemic encephalopathy

62
Q

Magnesium citrate 250 mls at bedtime

A

Bowel prep and to evacuate parasites and toxic materials from the colon

Adverse
Fluid & blood Electrolyte imbalances
Abdo cramps, dizziness, palpitations, weakness, excessive bowel activity, nausea

63
Q

Dulcolax correctol stimulants (bisa odyl) 2-3-5 mg po or 1-10 mg suppository qd as single dose

A

Acute or chronic constipation , preop prep or post op prep

Adverse
Risk for fluid and electrolyte imbalance, N/V, abdo cramps

64
Q

Colute, golytely, nulytely (polyethelene glycol with electrolytes) 4 L before GI exam po, 250 ml q10 min until fecal d/c is clear
NG 20-40 ml/min (1.2-1.8 L/h

A

Bowel prep before GI exam

Adverse
Nausea, bloating, cramps, diarrhea, excessive stool frequency rate cases urticaria

65
Q

Metamucil (Psyllium)

1 tsp, 1 tbs or 1 packet mix with 8 oz of water or other liquid

A

Constipation
Bowel mgt, IBS

Contraindication in fecal obstruction , fecal impaction and swallowing disorders

66
Q

Actidose wiyh sorbitol (sorbitol)

A

Short term tx of constipation

Can also be used in the mgt of poisoning or drug overdose by mixing with activated charcoal

Adverse hypermatremia

67
Q

Castor oil 15-60 ml

A

Short term tx for chronic constipation
Bowel prep for GI exam

Adverse
risk for fluid and electrolyte disturbance

68
Q

Fleet glycerin (glycerol) 1 suppositiry

A

Rectal evac in bowel training programs and re eatablishing normal bowel function, dependent on lacative and chronic constipation

69
Q 
Ethyl alcohol (ethanol) 100%  
0.5-1 ml inj/ varix to a max of 4 ml
A

Variceal bleeding

70
Q

Romazicon (flumazenil)

0.2-1 mg given at 0.2 mg/min IV no more than 1 mg at once

A

Benzodiazepines reversal

Adverse
Tachy, dry miuth, flushing, blurred vision. Inf site pain, dizziness, sweating, headache

71
Q

Midazolam

A

Premed for anxiety and reduced recall, sedation

72
Q

Valium (diazepam)

5-15 mg IV imm pre procedure and prn during

A

Pre procedural anciety and tension, reduced recall of the procedure

73
Q

Isordil (isosorbide dinitrte)

5-10 mg ac, SL

A

Achalasia

Adverse
Headache

74
Q

Procardia (nifedipine)

10-15 mg cap broken in patient’s mouth

A

Achalasia

75
Q

Rowasa enema

Canasa supp asa ol pentasa ( mesalamine) 5-ASA

A

Suspension retention enema and rectal supp for distal UC, proctosigmoiditis or proctitis

Oral agents to induce and maintain remission of UC and Crohn’s dse

76
Q

Lialda (mesalamine)

A

For induction of remission in patients with active, mild to mod UC

Adverse
Hepatitis, alopecia, flatulence, headache, pruritus

77
Q

Azulfidine ( sulfasalazine)
Initial -1-5 g/day in divided doses
Maint- 2 mg/day

A

UC

78
Q

Dipentum (olsalazine)

A

Maintain longterm freedom from sx of UC for patients who cannot take sulfasalazine

Contraindicated for patients allergic to salicylates such as aspirin

79
Q

Purinethol (azathioprine + 6 mp)

A

Immunomodulator for Crohn’s - induction of remission of steroid in refractory dse, steroid dependent and fistulizing dse, chronic steroid dependent UC

80
Q

Colazal (Balsalazide disodium converted to 5 ASA)

A

Tx to mild to mod active UC

81
Q

Remicade (infliximab)

5 mg/kg IV at 0,2 & 6 wks for maint up to 8 wks

Inc who respond but then lose their response

Discontinue if no response

A

Induction and maintenance or remission in patients w/ mod to severe Crohn’s who had inadequate response to conventional therapy

UC

Adverse
Test for TB before administration and monitor for ss of acute TB

82
Q

Humira (adalimumab)

A

Reduce ss and induction and maintaining remission with mod to severely active Crohn’s without response to conventional therapy

Adverse
Test for TB

83
Q

Tyzabri (natalizumab)

A

For patient’s who cannot tolerate TNF inhibitors. Crohn’s dse

Adverse
Dark urine, clay stool, jaundice, sx of liver damage, leucoencephalopathy

84
Q

Cholestyramine

A

Bile acid diarrhea. Relief for pruritus in patients w/ partial biliary obstructionist

85
Q

Creon5 (pancrelipase) 1-3 caps or tab ac or w/ meals

A

Exocrine pancreatic secretion insufficiency, digestive aid in cystic fibrosis, steatorrhea and other disorders for fat metabolism leads to insufficient pancreatic enzymes

86
Q

Neo- fradin (neomycin sulfate)

A

Infectious diarrhea of intestinal bacteria and hepatic encephalopathy

87
Q

Cuprimine depen (penicillamine)

A

Wilson’s dse, primary biliary cirrhosis, heavy metal poisoning

Adverse
leucopenia, thrombocytopenia

88
Q

Sandostatin ( ocreotide acetate)

IV, IM, SC

A 
Variceal bleed,
Carcinoid tumours
Gastrinoma
Small bowel or pancreatic tumour
GI bleed
Watery diarrhea with peptide secreting tumour
89
Q

Cyanocobalamin, USP

A

B12 def inc pernicious anemia, helatic or renal dse, addisonian, partial gastrectomy, malignancy of pancreas or bowel, folic a id def

90
Q 
Cifaxan 559 (Rifaximin)
550mg tab bid
A

Hepatic encephalopathy. Stops the growth of bacteria that produce toxins in intestinal tract

400 mg bid or tod for 10 days for IBS

200mg po tid for 3 days for traveler’s diarrhea

91
Q

Botox ( clostridium botulinum)

100 IU dissolved in 5 mls NS (20 IU/ml)

A

Treats dysphagia with preserved peristalsis and incomplete relaxation of LES

Inject in LES

Relaxation of sphincter of oddi in patients with acalculous biliary pain

92
Q

Kinevac ( sincalide)

A

Stimulate gallbladder contraction. Do not give to immunocompromised pts

Adverse

Abdo discom, nausea, cramping
Rare- stone dislodgement into cystic or CBD

93
Q

Viread (tenofovir) 300mg po a day

Baraclude (entecavir)

A

Antiviral for chronic Hep B

94
Q

Hep B vaccine (hep B immune globulin)

A

Recent exposure to hep B without prev hep b vax

95
Q

Pegasys+copegus ( peginterferon alfa-2A ribavirin

A

Hep C with compensated liver dse not been treated with interferone inc patients with compensated cirrhosis

96
Q

Revet, copegus (ribavirin)

A

Use in combination with inteon A (interferon alfa2b) tx for chronic hep C in patients with compensated liver dse not been treated for alpha interferon therapy or who had relapse from prev tx

97
Q

Urecholine (bethanicol)

25 mg qid taken 1 hr av or 2hr pc

A

GERD, gastroparesis

98
Q

Hurricaine (benzocaine)

Xylocaine (lidocaine HCL)

A

Suppresses gag reflex and controls pain

99
Q

Sottadecol (sodium tetradecyl sulfate) 1-3%

Ethamoli (ethanolamine oleate) prevent rebleeding of oesophageal varices

A

Obliteration of oesophageal varices

100
Q

Antacids neutralize gastric acid
No direct effect on gastric acid secretion

It reduces total acid load in the GIT leading to transient raising of gastric ph

It increases LES tone reducing reflux
Decrease pepsin activity- pepsin inactive in alkaline conditions.
Aluminum ions prevent smooth miscle contraction and gastric emptying.

True or false

A

True

101
Q

What is the tx if GERd, acid indigestion, hyperacidity associated with PUD, gastric hyperacidity and sour stomach. pyrosis(heartburn)?

A

Anatcids

102
Q

What does atropine do in GIT?

A

It prevents gastric acid secretion by blocking the acytylcholine receptor on gastric parietal cells.

It also decrease gi tone and motility.

103
Q

Anticholinergics is used in the tx of what?

A

DES, PUD, IBS, Diverticulitis, hypermotility disorders and UC

Contraindicated in patients who experience bleeding, tachycardia, glaucoma, achalasia, obstruction or suspected toxic mega colon.

Best given 1 hr when food stimulated acid is at its leak. Effects persist 2-5 hrs

104
Q

What are the adverse effects of anticholinergics? What

A

Dry mouth, nose and throat, horseness, tachycardia, blurred vision, urinary hesitancy or retention, flushing of the skin, constipation.

Due to its side effects, it is used as adjunctive therapy for PUD in combination with antacids or H2 blockers

105
Q

What are the cholinergic medications?

Cholinergics inc tone and motility and secretion eg diaphoresis and bladder contractions (parasympathetic stimulations)

Contraindicated in the presence of peptic ulcer or possible GI obstruction

Side effects- abdo cramping, blurred vision,

A

Bethanicol (urecholine) use to inc LES,
Domperidone (motilium) enhance gastric emptying
Like metoclopramide.
Cisapride (propulsid) increasing contraction in stomach to improve stomach emptying to releive sx of reflux oesophagitis ( limited access due to its side effects

106
Q

What other antidiarrheal meds are used for treating H. Pylori?

A

Bismuth useful for mild diarrhea and upset stomach by inhibiting intestinal secretions.

It may absorb toxins and provide protective coating for the mucosa

107
Q

What are the danger of antidiarrheal agents?

A

Not recommended for patients with fever and bloody diarrhea or younger than 2 yrs old.

It inhibits intestinal motility may develop toxic megacolon in patients suffering from pseudomembranous enterocolitis, acute dysentery and acute UC.

It should be used in acute IBD only after an infectious cause has been ruled out.

108
Q

What does promethiazines do?

Prochlorperazine and chlorpromazine are effective in gastroenteritis, radiation sickness and drug therapy not relieve motion sickness.

A

Common antiemetic that exert their effects on the cells of the chemoreceptor trigger zone(cTZ) located in the medulla of the brain stem which prevents the vomitting centre for being activated.

Adverse
Muscle twitching

109
Q

What are the indications for use of metronidazole?

A

Combat effects of intestinal parasites and fungi which demonstrate antimicrobial activity and antibacterial antiprotozoal and anti inflammatory effects.

It is also ised in Crohn’s dse include perineal dse, crohn’s colitis and sulfasalazine intolerance and allergy.

110
Q

What are the histamine 2 blockers?

A

Cimetidine(tagamet), famotidine(pepcid), nizatidine(Axid), ranitidine(zantac).
They reduce secretions of gastric acid by blocking histamine actions on the h2 receptor in the parietal cells.

It reduce gastric acid with UGI bleed stems from peptic ulcer.

111
Q

Sucralfate forms a viscous adhesive gel on the crater of ulcer.

Approved for the tx of duodenal ulcers but not for gastric ulcer

True or false

A

True

112
Q

What agents is used to prevent gastric ulcer and mucosal injury associated with the use of NSAIDS?

A

Prostaglandins such as misoprostol(cytotec)

Most common side effects is diarrhea followed by abdo pain

113
Q

What is the most effective agents used in GERD?

A

PPI- provide more control of acid than H2 blockers.

Needs to administer 30 mins before foodto activate PPI blockade

Used in patient’s with erosive oesophagitis or active duodenal ulcers. Long term tx for ZES

114
Q

H. Pylori tx

A

Lansoprazole
Clarithromycin (biaxin)
Amoxicillin

115
Q

In patient’s with Crohn’s, proctitis or distal colitis cortecosteroids is administered rectally foam or retention enema

True or false

A

True

UC (4 decks)

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