Exam 4 GI Assessment Part 2 [Ashley] Flashcards
Gastric outlet ____ onset may be ____ or ____
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obstruction
acute
slow
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acute gastric outlet obstructions are caused by what?
edema & inflammation in pyloric channel at the beginning of duodenum
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What are the symptoms of a pyloric obstruction? treatment?
recurrent vomiting, dehydration, and hyperchloremic alkalosis
Tx: NGT, IV hydration; normally resolves in 72hrs
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Repetitive ulceration and scarring may lead to ____ & ____
Fixed-stenosis & Chronic obstruction
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How many types of gastric ulcers are there? and what are they caused by?
5
Caused by NSAIDs, H. Pylori, and ETOH
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what is the treatment for gastric ulcers?
What is the specific treatment for H. pylori?
antacids, H2 blockers, PPIs, prostaglandin analogues, cytoprotective agents
H Pylori ts: triple therapy (2 abx and PPI) X 14d
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Classifications of gastric ulcers
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Describe Zollinger Ellison syndrome
Non B cell islet tumor of the pancreas, causing gastrin hypersecretion
Gastrin stimulates gastric acid secretion. Gastric acid normally inhibits further gastrin release (neg feedback)
This feedback loop is absent in ZE syndrome
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What are the symptoms associated with ZE syndrome?
peptic ulcer dz, erosive esophagitis, diarrhea
pts have increased gastric fluid vol, possible e-lytes imbalances, and endocrine abnormalities
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What types of patients experience ZE syndrome?
0.1-1% of PUD pts
M>F; most commonly b/w ages 30-50
up to 50% of pts with gastrinomas are metastatic at time of diagonsis
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Tx indicated for ZE syndrome
PPI and surgical resection of gastrinoma
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Pre-operative considerations for ZE syndrome
Correct e-lytes, increased gastric pH w/meds, RSI
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What is the function of the small intestines?
Small intestinal motility mixes the contents of the stomach w/ digestive enzymes, further reducing particle size and increasing solubility
The major function of the small intestine is to circulate the contents & expose them to the mucosal wall to maximize absorption of water, nutrients, and vitamins before entering the large intestine
The circular and longitudinal muscle layers coordinate to achieve segmentation
Segmentation: two nearby areas contract and thereby isolate a segment of intestine
Segmentation allows the contents to remain in the intestine long enough for the essential substances to be absorbed into the circulation
It is controlled mainly by the enteric nervous system with modulation of motility by the extrinsic nervous system
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when considering sm bowel dysmotility, it is helpful to distinguish eteliogies based on what?
Reversible and nonreversible causes
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What are the reversible causes of sm intestines?
mechanical obstruction such as hernias, malignancy, adhesions, and volvuluses
bacterial overgrowth leading to alterations in absorptive function
ileus, electrolyte abnormalities, and critical illness
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How is nonreversible sm bowel dysmotillity classified?
What are they?
structural or neuropathic
Structural: scleroderma, connective tissue disorders, IBD
Neuropathic:pseudo-obstruction in which the intrinsic and extrinsic nervous systems are altered and the intestines can only produce weak, uncoordinated contractions
–>This leads to bloating, nausea, vomiting, and abdominal pain
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How does the large intestine function?
Large intestine acts as reservoir for waste & indigestible material before elimination, & it extracts remaining electrolytes & water
Distention of the ileum will relax the ileocecal valve to allow intestinal contents to enter the colon
Subsequent cecal distention will contract the ileocecal valve
The colon also exhibits giant migrating complexes
Giant migrating complexes serve to produce mass movements across the large intestine
In the healthy state, these complexes occur approximately 6-10x a day
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What 2 primary symptoms manifest with colonic dysmotility?
altered bowel habits and/or intermittent cramping
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Most common diseases assd w/ colonic dysmotility
IBS and IBD
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Rome II criteria define IBS as having what?
abdominal discomfort along with 2 of the following features:
-defecation relieves discomfort
-pain is assoc w/abnormal frequency (> 3x per day or < 3xper week)
-pain is associated with a change in the form of the stool
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In ____ contractions are ____ d/t colonic wall ____ by the inflamed gastric mucosa, but the ____ remain
IBD
suppressed
compression
giant migrating complexes
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If there is an increased frequency of giant migrating complexes, what happens?
their pressure-effect further compresses the inflamed mucosa, which can lead to hemorrhage, thick mucus secretion, and significant erosions
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What are the common inflammatory bowel diseases?
What is their incidence?
IBD is the 2nd most common inflammatory disorder (RA is 1st)
UC
Chrones
18:100,000
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what is ulcerative colitis?
what happens in severe cases?
Normal symptoms?
Mucosal dz of rectum and part or all of the colon
In severe cases, the mucosa is hemorrhagic, edematous, ulcerated
Sx: diarrhea, rectal bleeding, crampy abdominal pain, N/V, fever, weight loss
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What labs might be seen in UC?
↑plts,↑erythrocyte sedimentation rate,↓H&H,↓albumin
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What warrants surgical colectomy with UC?
Hemorrhage requiring 6+ units blood in 24-48hrs
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Toxic megacolon is a complication of ____ triggered by ____
what percentage of cases resolve? require colectomy?
what is the most dangerous complication of toxic megacolon?
UC, e-lyte distrubances
1/2 and 1/2
colon perforation: mortality rate 15%
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what is Crohn’s disease?
Where is the most common site?
Acute or chronic inflammatory process that may affect any/all of the bowel
Most common site is the terminal ilium, usually presenting w/ileocolitis, RLQ pain & diarrhea
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