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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
Flagyl (metronidazole)
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
26
Piptaz
Prophylaxis for duodenal and colorectal surgery
27
Metopenem
Certain serious intra-abdominal infections. ICU patients with severe diverticulitis
28
Ciprofloxacin (fluoroquinolones)
Hospitalized patients with mild to moderate diverticulitis ICU patients with severe diverticulitis
29
Levbid, levsinex, nulev (Hyoscyamine sulfate)
Tx for GI spasms and hypermotility, conjunct yherapy for peptic ulcer dse, IBS, diverticulitis, colitis or pain, hypersecretion pancreatitis
30
Pepto-bismol (bismuth subsalicylate)
Diarrhea, heartburn, indigestion, upset stomach, nausea Contraindication for patients allergic to aspirin or salicylates May cause darkening of stool and tongue discoloration
31
Lomotil (diphenoxylate HCL attopine sulfate opiate and opiod derivatives)
Diarrhea
32
Imodium (loperamide HCL opiate opiod derivatives)
Acute, non specific diarrhea and chronic diarrhea associated with IBS, chronic traveler’s diarrhea
33
Cholestyramine
Bile acid induced diarrhea Less frequent Adverse effects Abdo discomfort, vit A, D K def,bleeding, steatorrhea, heartburn, diarrhea, n/v, Most common constipation
34
Thorazine (Chlorpromazine HCL)
N/v, control of hiccups
35
Dramamine (dimenhydrinate)
Tx of motion sickness
36
Reglan (metoclopramide)
Prevent chemo n/v Prevent post op n/v
37
Compazine (prochlorperazine)
Severe N/V
38
Tigan (trimethobenzamide)
N/V in gastroenteritis, post op N/V
39
Zofran (ondansetton HCL)
N/V drugs from 5 HT3 antagonists. Acute emesis but only a minor role in delayed N/V
40
Inapsine (droperidil)
Premed for surgery of diagnostic procedure
41
Mylicon gasx beano (simethicone)
Relief of painful symptome of excess gas in GIT
42
Pepcid oral suspension, chewable tablets/gel/caps (famotidine)
ZES agents, oesophagitis, GERD, duodenal ulcer. H. Pylori tx regiment
43
Tagamet (cimetidine)
GERD, heartburn ``` Duodenal ulcer (DU) GU, PU ```
44
Zantac (Ranitidine HCL)
PU dse, Duodenal Ulcer ZES agent Adverse effects Blood count changes, arthralgia, arrythmias
45
Carafate (Sucralfate) 1g po qid 1 ac or 2 hr pc
Short term tx of Duodenal Ulcer Adverse effects Must separate concurrent drugs by at least 3 hrs
46
Cytotec (misoprolol) 200mcg po qid with food
Prevention of NSAIDS induced ulcers
47
Prilosec (omeprazole) 20 mg >20 kg for GERD/erosive oesophagitis 20 mg qd 10 mg qd <20 kg
Erosive oesophagitis, heartburn, GERD Short term tx of active benign gastric ulcers, DU ZES
48
``` 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
GERD, erosive oesophagitis, ZES
49
Aciphex (rabeprazole)
Heartburn, GERD | Suspected onown H. Pylori related to PU/DU
50
Hydrocortisone (anti inflammatory)
UC/Crohn’s Adverse effects Cushingoid changes, fluid & electrolyte disturbances, osteoporosis, pancreatitis, growth suppression, diabetes, GU, glaucoma
51
Entocort EC (budesonide)
Mild to mod active crohn’s involving ileum and ascending
52
Prednisone
Mod to severe crohn’s dse
53
Medrol (Methylprednisolone)
UC/Crohn’s, shock, severe lupus nephritis ascites, spinal cord injurypneumocystic carinii pneumonia
54
Kenalog (triamcinolone acetonide) not for IV ise. 1 mg intralesional use only Use in each quadrant of the narrowest region of the stricture
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
Actigall (ursodiol) clfor chronic cholestasis
Dissolution of radiolucent cholesterol stone less than 20 mm in diameter
56
Glucagon 0.2-0.4 mg IV
Inhibit GI motility esp inconjunction with ERCP Adverse N/V
57
Pentagastrin
Stimulates gastric acid secretion Adverse Flushing lightheadedness abdo discom, N
58
Secretin 2 units/kg over 1 min
Stimulates pancreatic exocrine, diagnosis of gastrinoma
59
Gallbladder therapeutic agents | Chenodiol
Dissolution of radiolucent cholesterol stones Adverse Reversible elevated hepatic enzymes, cramps, heartburn, diarrhea
60
Docusate sodium/sennosides 2-4 tabs qd
Constipation
61
Lactulose 15-30 mls po/day- constipation 30-45mls tid/qid for portal systemic enteropathy Or as a retention to reverse hepatic coma
Constipation, portal systemic encephalopathy
62
Magnesium citrate 250 mls at bedtime
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
Dulcolax correctol stimulants (bisa odyl) 2-3-5 mg po or 1-10 mg suppository qd as single dose
Acute or chronic constipation , preop prep or post op prep Adverse Risk for fluid and electrolyte imbalance, N/V, abdo cramps
64
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
Bowel prep before GI exam Adverse Nausea, bloating, cramps, diarrhea, excessive stool frequency rate cases urticaria
65
Metamucil (Psyllium) 1 tsp, 1 tbs or 1 packet mix with 8 oz of water or other liquid
Constipation Bowel mgt, IBS Contraindication in fecal obstruction , fecal impaction and swallowing disorders
66
Actidose wiyh sorbitol (sorbitol)
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
Castor oil 15-60 ml
Short term tx for chronic constipation Bowel prep for GI exam Adverse risk for fluid and electrolyte disturbance
68
Fleet glycerin (glycerol) 1 suppositiry
Rectal evac in bowel training programs and re eatablishing normal bowel function, dependent on lacative and chronic constipation
69
``` Ethyl alcohol (ethanol) 100% 0.5-1 ml inj/ varix to a max of 4 ml ```
Variceal bleeding
70
Romazicon (flumazenil) | 0.2-1 mg given at 0.2 mg/min IV no more than 1 mg at once
Benzodiazepines reversal Adverse Tachy, dry miuth, flushing, blurred vision. Inf site pain, dizziness, sweating, headache
71
Midazolam
Premed for anxiety and reduced recall, sedation
72
Valium (diazepam) | 5-15 mg IV imm pre procedure and prn during
Pre procedural anciety and tension, reduced recall of the procedure
73
Isordil (isosorbide dinitrte) | 5-10 mg ac, SL
Achalasia Adverse Headache
74
Procardia (nifedipine) | 10-15 mg cap broken in patient’s mouth
Achalasia
75
Rowasa enema | Canasa supp asa ol pentasa ( mesalamine) 5-ASA
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
Lialda (mesalamine)
For induction of remission in patients with active, mild to mod UC Adverse Hepatitis, alopecia, flatulence, headache, pruritus
77
Azulfidine ( sulfasalazine) Initial -1-5 g/day in divided doses Maint- 2 mg/day
UC
78
Dipentum (olsalazine)
Maintain longterm freedom from sx of UC for patients who cannot take sulfasalazine Contraindicated for patients allergic to salicylates such as aspirin
79
Purinethol (azathioprine + 6 mp)
Immunomodulator for Crohn’s - induction of remission of steroid in refractory dse, steroid dependent and fistulizing dse, chronic steroid dependent UC
80
Colazal (Balsalazide disodium converted to 5 ASA)
Tx to mild to mod active UC
81
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
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
Humira (adalimumab)
Reduce ss and induction and maintaining remission with mod to severely active Crohn’s without response to conventional therapy Adverse Test for TB
83
Tyzabri (natalizumab)
For patient’s who cannot tolerate TNF inhibitors. Crohn’s dse Adverse Dark urine, clay stool, jaundice, sx of liver damage, leucoencephalopathy
84
Cholestyramine
Bile acid diarrhea. Relief for pruritus in patients w/ partial biliary obstructionist
85
Creon5 (pancrelipase) 1-3 caps or tab ac or w/ meals
Exocrine pancreatic secretion insufficiency, digestive aid in cystic fibrosis, steatorrhea and other disorders for fat metabolism leads to insufficient pancreatic enzymes
86
Neo- fradin (neomycin sulfate)
Infectious diarrhea of intestinal bacteria and hepatic encephalopathy
87
Cuprimine depen (penicillamine)
Wilson’s dse, primary biliary cirrhosis, heavy metal poisoning Adverse leucopenia, thrombocytopenia
88
Sandostatin ( ocreotide acetate) | IV, IM, SC
``` Variceal bleed, Carcinoid tumours Gastrinoma Small bowel or pancreatic tumour GI bleed Watery diarrhea with peptide secreting tumour ```
89
Cyanocobalamin, USP
B12 def inc pernicious anemia, helatic or renal dse, addisonian, partial gastrectomy, malignancy of pancreas or bowel, folic a id def
90
``` Cifaxan 559 (Rifaximin) 550mg tab bid ```
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
Botox ( clostridium botulinum) | 100 IU dissolved in 5 mls NS (20 IU/ml)
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
Kinevac ( sincalide)
Stimulate gallbladder contraction. Do not give to immunocompromised pts Adverse Abdo discom, nausea, cramping Rare- stone dislodgement into cystic or CBD
93
Viread (tenofovir) 300mg po a day Baraclude (entecavir)
Antiviral for chronic Hep B
94
Hep B vaccine (hep B immune globulin)
Recent exposure to hep B without prev hep b vax
95
Pegasys+copegus ( peginterferon alfa-2A ribavirin
Hep C with compensated liver dse not been treated with interferone inc patients with compensated cirrhosis
96
Revet, copegus (ribavirin)
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
Urecholine (bethanicol) | 25 mg qid taken 1 hr av or 2hr pc
GERD, gastroparesis
98
Hurricaine (benzocaine) Xylocaine (lidocaine HCL)
Suppresses gag reflex and controls pain
99
Sottadecol (sodium tetradecyl sulfate) 1-3% Ethamoli (ethanolamine oleate) prevent rebleeding of oesophageal varices
Obliteration of oesophageal varices
100
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
True
101
What is the tx if GERd, acid indigestion, hyperacidity associated with PUD, gastric hyperacidity and sour stomach. pyrosis(heartburn)?
Anatcids
102
What does atropine do in GIT?
It prevents gastric acid secretion by blocking the acytylcholine receptor on gastric parietal cells. It also decrease gi tone and motility.
103
Anticholinergics is used in the tx of what?
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
What are the adverse effects of anticholinergics? What
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
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,
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
What other antidiarrheal meds are used for treating H. Pylori?
Bismuth useful for mild diarrhea and upset stomach by inhibiting intestinal secretions. It may absorb toxins and provide protective coating for the mucosa
107
What are the danger of antidiarrheal agents?
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
What does promethiazines do? Prochlorperazine and chlorpromazine are effective in gastroenteritis, radiation sickness and drug therapy not relieve motion sickness.
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
What are the indications for use of metronidazole?
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
What are the histamine 2 blockers?
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
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
True
112
What agents is used to prevent gastric ulcer and mucosal injury associated with the use of NSAIDS?
Prostaglandins such as misoprostol(cytotec) Most common side effects is diarrhea followed by abdo pain
113
What is the most effective agents used in GERD?
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
H. Pylori tx
Lansoprazole Clarithromycin (biaxin) Amoxicillin
115
In patient’s with Crohn’s, proctitis or distal colitis cortecosteroids is administered rectally foam or retention enema True or false
True

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