Final Exam - GI conditions Flashcards
Ulcerative colitis affects what part of the GI tract?
Colon only
What is ulcerative colitis?
Inflammatory bowel disease-the mucosal surface of the colon is inflamed-most often occurs in the rectosigmoid areas, but may involve the entire colon
Results in friability, erosions, and bleeding
Symptoms of ulcerative colitis
Bloody, purulent diarrhea
What treatment can completely resolve ulcerative colitis?
Total surgical colectomy
Symptoms of diverticulitis
Bleeding not associated with pain or discomfort
What patients are at higher risk for diverticulitis?
Obese patients
Signs of inflamed diverticula
Normal signs and symptoms of infection
- fever
- chills
- tachycardia
How do patients with diverticulitis present?
- LLQ pain and tenderness
- anorexia
- nausea
- vomiting
Diagnosing diverticulitis
CT with contrast to rule out gyn problems (ovarian cyst or tumor) and bowel pathology like abscess
Management for diverticulitis
High fiber diet
Clostridium difficile
Infection of the large intestine that causes profuse, watery, mucoid diarrhea.
Can be dangerous or life threatening if not treated
C Diff risk factors
- working in healthcare facility
- long duration hospitalization
- Long-term use of antibiotics that affects normal GI flora
- Long-term use of medications that reduce GI acidity
- consuming contaminated food/water
- contact with infected soil, objects and surfaces
C Diff symptoms
- may be asymptomatic
- profuse, watery, mucoid diarrhea
- Mild to moderate infection
- Watery diarrhea three or more times/day for two or more days
- Mild abdominal cramping and tenderness - Severe infection:
- Watery diarrhea (10-15 stools/day)
- Strong foul odor
- Acute abdomen secondary to toxic megacolon with perforation
- Abdominal distention
- Fever
- Nausea/vomiting/dehydration requiring hospitalization
- Blood/pus in stool (severe cases)
C Diff diagnosis
- CBC
- Enzyme-linked immunodeficiency assay (ELISA): identifies toxins that produce C. diff bacteria
- Cell cytotoxicity assay: identifies the effects of bacterial toxins on human cells
- Polymerase chain reaction (PCR): detects bacterial genes
- Endoscopy: if the patient is unresponsive to treatment; will show pseudomembranes that suggest c-diff infection
C Diff treatment
- Metronidazole
- Probiotics- to restore the healthy growth of normal GI bacteria
- Colectomy in severe cases
- Maintain fluids
- Clear liquid diet
- Eat starchy foods to prevent diarrhea
- Avoid caffeine, spicy foods, milk and greasy foods
- May require a GI consult
Causes of GERD
- Lower esophageal sphincter (LES) dysfunction: reduced pressure or improper relaxation allows gastric acid to flow back into the esophagus
- Hiatal hernia: contributes to GERD by disrupting the normal barrier between the esophagus and stomach
- Esophageal motility disorders: impaired esophageal peristalsis and reduces esophageal clearance can lead to pooling of gastric acid in the esophagus
- Acidic acid contents
Symptoms of GERD
- Regurgitation at night
- heartburn (mild to sever)
- Dysphagia
- regurgitation,
- water brash (reflex salivation)
- sour taste in the mouth in the morning,
- odynophagia (pain with swallow)
- belching
- coughing,
- hoarseness
- wheezing, usually at night.
Treatment for GERD
6 weeks of omeprazole & diet modifications
- if no improvement of symptoms then endoscopy
Patient education for GERD
Avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6- to 8-in blocks; and refrain from eating for 3 hours before retiring.
Aggressive factors for Peptic Ulcer Disease
- H. pylori
- Gastric acid hypersecretion
- NSAIDS
- Lifestyle factors
Protective factors for Peptic Ulcer Disease
- Mucus and bicarbonate secretion
- Prostaglandins
- Mucosal blood flow
- Epithelial cell renewal
Peptic ulcer disease hallmark signs
a complaint of burning or gnawing (hunger) sensation or pain (dyspepsia) in the epigastrium, which is often relieved by foods or antacids
Treatment for peptic ulcer disease
Amoxicillin, clarithromycin, and omeprazole for 2 weeks
Physical exam findings with peptic ulcer disease
- Tachycardia (associated with IDA)
- Pale conjunctivae (associated with IDA)
- Burning epigastric tenderness
- Severe, generalized abdominal pain
- Rectal exam (occult blood guiac positive)
Risk factors for peptic ulcer disease
- H. Pylori
- NSAID use
- Smoking
- excessive alcohol use
- more common over 60
- stress can delay healing
Risk factors for GERD
- Smoking
- stress
- obesity
- hiatal hernia
- pregnancy
- smoking
- certain foods/drinks
- medications
Physical exam findings for Peptic Ulcer Disease
- Abdominal tenderness (usually epigastric)
- abdominal distention
- occult blood in stool
- guarding or rigidity (severe cases)
- signs of anemia
Physical exam findings for GERD
- burning sensation in chest
- regurgitation (sensation of acid refluxing in throat/mouth)
- Odynophagia (pain or discomfort swallowing)
- hoarseness
- dental erosion
- cough (chronic at night or after meals)
Rotavirus
Viral infection most common in children under three
Symptoms of rotavirus
- low-grade fever,
- loss of appetite,
- copious watery diarrhea,
- flatulence,
- vomiting,
- stomach cramps.
Treatment for rotavirus
- fluids
- supportive care
- antiemetics
Symptoms of appendicitis
- Constant periumbilical pain shifting to the right lower quadrant; vomiting following the pain; a small volume of diarrhea; may not always vomit
- pain (dull, sharp, mild or severe); fever, chills, loss of appetite, malaise, diarrhea, nausea or vomiting
Most common cause of appendicitis
Fecalith - stone made of feces typically found in the colon
Labs for appendicitis
Mild elevation of the white blood cell count with an early left shift; and white blood cells (WBCs) or red blood cells (RBCs) in the urine are indications of appendicitis.
The WBC count becomes high only with gangrene or perforation of the appendix
Obturator sign
Used to diagnose appendicitis.
Is elicited when, with the patient’s right hip and knee flexed, the examiner slowly rotates the right leg internally, which stretches the obturator muscle. Pain over the right lower quadrant (RLQ) is considered a positive sign.
Treatment for appendicitis
Antimicrobial therapy and surgery
Gastroenteritis
Bacterial or viral intestinal infection that spreads through contact usually fecal-oral.
Inflammation of the stomach and intestine.
Symptoms of gastroenteritis
- Watery diarrhea
- Nausea and vomiting
- Abdominal pain and cramping
- Low grade fever, headache
dehydration - anorexia
Causes of gastroenteritis
Usually infectious: can be caused by bacteria, viruses, parasites, injury to the bowel mucosa, inorganic poisons (sodium nitrate), organic poisons (mushrooms or shellfish), and drugs.
Chronic causes include food allergies and intolerance, stress, and lactase deficiency.
If caused by bacterial toxin then called food poisoning
Diagnosing gastroenteritis
Stool culture, Check stool for leukocytes, lactoferrin and blood and parasites
Differential diagnoses for gastroenteritis
- irritable bowel syndrome
- IBD
- ischemic bowel disease (especially in patients with peripheral vascular disease)
- partial bowel obstruction
- pelvic abscess
H. pylori
Type of bacteria that infects your stomach.
It attacks your stomach and the first part of your small intestine (duodenum).
This can cause redness and swelling (inflammation).
Many people with the bacteria won’t have any symptoms.
It can cause open sores called peptic ulcers in your upper digestive tract.
Cause of H. pylori
Caused by poor hygiene, untreated water
Signs and symptoms of H. pylori
-ache or burning pain in stomach
- stomach pain worse when empty
-nausea
-loss of appetite
-burping
-bloating
- weight loss
Treatment for H. pylori
Amoxicillin, clarithromycin and omeprazole for two weeks
Causes of diarrhea
-acute viral gastroenteritis
IBS, IBD, ingestion of magnesium-containing antacids, lactose intolerance, antibiotic therapy, laxative abuse, and AIDS
Differential diagnoses for diarrhea
IBS, medications, dietary factors, IBD, and colon cancer.
Giardia
a protozoan that attaches to the mucosa of the small bowel.
Causes of giardia
Ingestion of contaminated food or water
Treatment for Giardia
Oral medications (metronidazole, tinidazole)
Quinacrine hydrochloride (Atabrine) 100 mg three times daily after meals for 5–7 days
OR
Metronidazole (Flagyl) 250 mg three times daily for 5–7 days.
Symptoms of salmonella
- Diarrhea
- Abdominal cramps
- Fever
- Nausea
- Vomiting
- Headache
- foul smelling stool
Treatment for salmonella
- Fluid replacement to prevent dehydration
- Antibiotics in severe cases
No treatment is necessary unless associated with fever and systemic disease.
Treatment includes trimethoprim-sulfamethoxazole (Bactrim DS) or a quinoline, norfloxacin 400 mg or ofloxacin 400 mg PO twice daily for 7–10 days.
Stress proper handling of food, thorough cooking, and good hand washing.
Symptoms of Giardia
- Diarrhea
- Abdominal cramps
-Bloating
-Gas
-Nausea - Weight loss
Cause of salmonella
Consumption of contaminated food, especially raw or undercooked poultry, eggs, meat, and dairy products
