Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AS - N935 Advanced Patho II > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Achalasia

A

Esophageal motility disorder (neuromuscular)

Outflow obstruction d/t inadequate LES relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Achalasia S/S

A

Dysphagia
Heartburn
Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Achalasia Diagnosis

A

Esophagram reveals “bird’s beak” appearance
EGD
Esophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Achalasia Type 1

A

Classic minimal esophageal pressure

Treatment = myotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Achalasia Type 2

A

Entire esophagus pressurization

Best outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Achalasia Type 3

A

Esophageal spasm w/ premature contractions

Worst outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Achalasia Treatment

A 
Palliative 
Relieve obstruction (does not correct lacking peristalsis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Distal Esophageal Spasm

A

Diffuse esophageal spasm
Elderly patients
ANS dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Distal Esophageal Spasm Diagnosis

A

Esophagram reveals “corkscrew” or “rosary bead” esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Distal Esophageal Spasm Treatment

A

Pain mimics angina

Responds to Nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GERD

A

Gastroesophageal reflux disease

LES incompetence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GERD S/S

A

Heartburn
Regurgitation
Less common include dysphagia & chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GERD Complications

A

Chronic peptic esophagitis
Strictures
Ulcers
Barrett’s metaplasia associated w/ adenocarcinoma
Reflux into pharynx, larynx, & tracheobronchial tree
Aspiration → pulmonary fibrosis or chronic asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GERD Treatment

A 
Lifestyle modification
Avoid foods that impair LES tone (fat, alcohol, peppermint, chocolate) & acidic
Pharmacological 
- PPI ↑pH & allows esophagus to heal
- H2 antagonists
Surgical = Nissen fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

↑aspiration risk associated w/ ___ mL & ___ pH

A

25mL or 0.4mL/kg

pH <2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Esophageal Diverticula

A

Esophageal structural disorder w/ outpouchings
Most common locations:
- Pharyngoesophageal (Zenker’s diverticulum)
- Mid-esophageal
- Epi-phrenic (supradiaphragmatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hiatal Hernia

A

Stomach herniates into thoracic cavity via diaphragm esophageal hiatus
Asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Esophageal Tumors

A

Progressive dysphagia to solid food & weight loss
Poor survival rate (lymph node metastasis)
Adenocarcinoma
Mortality rate about 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Esophageal Tumor Treatment

A

Esophagectomy (curative or palliative)

Thoracic epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Esophageal Tumors Complications

A

ARDS
Malnourished
Dehydration
RLN injury risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Peptic Ulcer Disease

A

Epigastric pain exacerbated by fasting & improved by eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

H. Pylori

A

Associated w/ PUD

Induces acid secretion via pro-inflammatory cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Gastric Ulcer

A

1/3 duodenal
Benign ulcers
Most common cause = NSAID use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Stress Gastritis

A

Associated w/ shock, sepsis, respiratory failure, burns, hemorrhage, massive transfusions, or head injury
Gastric bleeding when coagulopathy, thrombocytopenia, INR >1.5, and aPTT >2x normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Zollinger-Ellison Syndrome

A 
Gastroduodenal & intestinal ulceration
↑gastrin secretion
Non-beta islet cell pancreatic tumor
Primarily men 30-50yo
Associated w/ MEN1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ZES S/S

A

Abdominal pain
Peptic ulceration
Diarrhea
GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ZES Treatment

A

Obtain fasting gastrin level
↑PPIs dosages
Surgical tumor resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PUD Complications

A

Bleeding
- Hemorrhage = leading cause of death
Perforation (risk 10%)
- Severe epigastric pain caused by highly acidic gastric contents in peritoneum
Obstruction
- Gastric outlet obstruction
- Cause = edema & inflammation in the pyloric channel & duodenum 1st portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PUD Treatment

A 
Antacids
H2 receptor antagonists
PPIs
Prostaglandin analogues
Cytoprotective agents
Anticholinergics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Antacids

A

Aluminum hydroxide
Magnesium hydroxide
Avoid in chronic renal failure patients → hypermagnesemia & neurotoxicity
TUMS = calcium carbonate (milk-alkali syndrome hypercalcemia, hyperphosphatemia, & renal calculi)
HCO3 → metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

H2 Receptor Antagonists

A

Cimetidine, Ranitidine, Famotidine, & Nizatidine
Inhibit basal & stimulated gastric acid secretion
Cimetidine & Ranitidine bind to CYP450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

PPIs

A

Proton pump inhibitors
Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, & Rabeprazole
Covalent, irreversible bond
Inhibit hydrogen-potassium ATPase pump
Most potent drug available
Inhibit ALL gastric acid secretion phases
Interfere w/ Ketoconazole, Ampicillin, Iron, Digoxin, & Diazepam absorption
Omeprazole & Iansoprazole inhibit CYP450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Prostaglandin Analogues

A

Misoprostol only FDA approved
Contraindicated in pregnancy
Enhance mucosal HCO3 secretion, stimulate mucosal blood flow, & ↓mucosal cell turnover
Most common side effect = diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Cytoprotective Agents

A

Sucralfate provides physiochemical barrier, enhances defense & repair
Most common side effect = diarrhea

Colloidal bismuth (Pepto) MOA unknown & neurotoxicity risk

35
Q

Anticholinergics

A

Inhibit muscarinic receptors activation in parietal cells
Negative side effects
Not routinely used

36
Q

Post-Gastrectomy

Dumping Syndrome

A

Hyperosmolar gastric contents enter into proximal small bowel
Fluid shifts into small bowel lumen
Results in plasma volume contraction & acute intestinal distention

37
Q

Early Dumping Syndrome

A

Symptoms 15-30min after meal (nausea, epigastric discomfort, diaphoresis, cramps, diarrhea, tachycardia, palpitations, dizziness, syncope)

38
Q

Late Dumping Syndrome

A

Symptoms 1-3hrs after meal

Vasomotor symptoms 2° to hypoglycemia d/t excessive insulin release

39
Q

Dumping Syndrome Treatment

A 
Dietary modifications (fewer simple sugars) & less fluid consumption during meals
Octreotide therapy - admin SQ before meal or depot injection monthly
- Inhibit release vasoactive peptides from gut, ↓peak plasma levels, & slow intestinal transit
40
Q

Post-Gastrectomy

Alkaline Reflux Gastritis

A

Clinical triad:
- Post-prandial epigastric pain associated w/ N/V
- Evidence bile reflux into stomach
- Histologic evidence gastritis
Treatment = divert intestinal contents from contact w/ gastric mucosa (diversion)

41
Q

Inflammatory Bowel Disease

A

Ulcerative colitis

Crohn’s disease

42
Q

Ulcerative Colitis

A

IBD
Involves rectum & extends proximally to involve part or all colon
Mucosal disease

43
Q

UC S/S

A

Diarrhea, rectal bleeding, tenesmus (feeling incomplete BM), passage mucus, & cramps
Anorexia, N/V, fever, weight loss
Low serum albumin & leukocytosis when severely ill

44
Q

UC Complications

A

Hemicolectomy when patient requires 6-8 units PRBCs w/in 24-48hrs
Toxic megacolon - dilated transverse colon w/ loss haustrations triggered by electrolyte abnormalities & narcotics
Perforation → peritonitis
Obstruction d/t benign stricture formation
Total proctocolectomy = curative

45
Q

Crohn’s Disease

A

IBD
Acute or chronic bowel inflammation
Penetrating-fistulous or obstructing pattern
Most common site = terminal ileum

46
Q

Crohn’s S/S

A

Ileocolitis
Recurrent episodes RLQ pain & diarrhea
Fever indicates intraabdominal abscess formation
Weight loss d/t anorexia & diarrhea
Loss digestive & absorptive surface → megaloblastic anemia & neurologic symptoms
Hypoalbuminemia, hypocalcemia, hypomagnesemia, coagulopathy, hyperoxaluria, & nephrolithiasis
Vitamin D deficiency, hypocalcemia, & glucocorticoid use
B12 malabsorption → megaloblastic anemia & neurologic symptoms
Diarrhea d/t bacterial overgrowth in obstruction areas, fistulas, bile acid malabsorption, ↓H2O reabsorption
1/3 patients at least 1 symptoms outside intestines (arthritis or renal calculi)

47
Q

IBD Surgical Treatment

A

NOT curative
Severe IBD → total proctolectomy & end ileostomy
Most common surgery = small intestine resection
Removal > 2/3 small intestine → short bowel syndrome & need parenteral nutrition

48
Q

IBD Crohn’s Surgical Complications

A

Hemorrhage
Sepsis
Neural injury

49
Q

IBD Medical Treatment

A

5-ASA (Mesalamine) to treat mild to moderate IBD
- Antibacterial & anti-inflammatory
Glucocorticoids moderate to severe Crohn’s only to induce remission & then taper (not maintenance)
Antibiotics “pouchitis” (Ciprofloxacin & Metronidazole)
Azathioprine, Methotrexate, Cyclosporine, & Tacrolimus
Infliximab & Natalizumab

50
Q

Carcinoid Tumors

A

Tumors originate in GI tract
< 1/4 first found in the lung
Secrete GI peptides/vasoactive substances
Often found incidentally (suspected appendicitis)
Sometimes contain GI peptides
Midgut more likely to release substances than foregut carcinoids

51
Q

Carcinoid Syndrome

A

Approximately 10%

Serotonin & vasoactive substances released into systemic circulation

52
Q

Carcinoid Syndrome S/S

A 
Sudden onset flushing & diarrhea
Flushing d/t histamine (admin H1 & H2 blockers)
Hypo or hypertension
Bronchoconstriction
Cardiac manifestations
53
Q

Carcinoid Syndrome

Precipitating Factors

A

Stress, alcohol, exercise, certain foods, & drugs such as catecholamines, pentagastrin, & SSRIs/SNRIs

54
Q

Carcinoid Syndrome Diagnosis

A

Measure urinary or plasma serotonin
Serotonin metabolites present in urine
1° metabolite: 5-HIAA (5-hydroxyindoleacetic acid)

55
Q

Carcinoid Crisis

A 
Intense flushing
Diarrhea
Abdominal pain
Tachycardia
Hypo or hypertension
Causes include stress, chemo, or biopsy
AVOID Succinylcholine, Miva/Atracurium, Epi/NE, Dopamine, Isoproterenol, or Thiopental
56
Q

Carcinoid Tumor Treatment

A

Avoid flushing
Serotonin receptor antagonists
5HTZ or 5HT3 antagonists
H1/H2 antagonists
Somatostatin analogues
Bronchoconstriction resistant to treatment β agonists worsen effects d/t mediator release
TACE - trans-arterial chemoembolization w/ or w/o chemotherapy

57
Q

Acute Pancreatitis

A

Pancreas inflammatory disease caused by digestive enzyme
Autodigestion prevented by enzymes being packaged in precursor form, protease inhibitors synthesis, & low calcium concentrations ↓trypsin activity

58
Q

Acute Pancreatitis

Causes

A

Gallstones & ETOH abuse
Hypercalcemia (hyperparathyroidism & AIDs)
Postop pancreatitis after CABG & ERCP

59
Q

Acute Pancreatitis

S/S

A

Excruciating mid-epigastric pain that radiate to the back
Sitting/leaning forward ↓pain
Abdominal distension w/ ileus
Dyspnea indicates pleural effusion or ascites
Low grade fever
Hypotension & tachycardia
Shock d/t hypovolemia (blood & plasma exudation into retroperitoneal space, kinins release, & systemic pancreatic enzymes effects)
↑serum amylase & lipase

Diagnosis CT w/ contrast

60
Q

Acute Pancreatitis

Treatment

A 
ERCP (when caused by gallstones)
Aggressive IVF admin
Colloid replacement
NPO to rest pancreas
- NJ tube feeding 
NG tube LIS
Stent placement
Opioids
Stone extraction
Sphincterotomy
61
Q

Acute Pancreatitis

Differential Diagnoses

A 
Perforated duodenal ulcer
Acute cholecystitis
Mesenteric ischemia
Bowel obstruction
Acute MI
Pneumonia
62
Q

Acute Pancreatitis

Complications

A

Shock, hypoxemia, ARDS, GI hemorrhage & coagulation defects, DIC, infection or abscess formation

63
Q

Chronic Pancreatitis

A

Chronic inflammation leads to irreversible damage to pancreas
Loss exocrine & endocrine function

64
Q

Chronic Pancreatitis

Causes

A

Chronic ETOH abuse
Especially w/ high protein diet
Genetic defects (idiopathic chronic pancreatitis)
Occurs w/ CF & hyperparathyroidism

65
Q

Chronic Pancreatitis

Diagnosis

A

History chronic ETOH abuse + pancreatic calcifications
Thin or emaciated - maldigestion proteins & fats
Normal serum amylase
U/S reveals enlarged pancreas or pseudocyst
ERCP most sensitive imaging test

66
Q

Chronic Pancreatitis

S/S

A

Epigastric pain that radiates to back
Frequent after eating
1/3 painless
Steatorrhea when 90% exocrine function lost
Diabetes d/t impaired or lost endocrine function

67
Q

Chronic Pancreatitis

Treatment

A

Manage pain, malabsorption, & diabetes
Opioids
Celiac plexus blockade
Pancreatic jejunostomy - internal surgical drainage procedure
Endoscopic stent placement & remove stones
Enzyme supplements to help fat & protein absorption
Insulin replacement/therapy

68
Q

Upper GI Bleed

A

Most common
Due to peptic ulcer disease
Mortality >30% elderly, esophageal varices, cancer, & hospitalized patients
1° cause of death MODS rather than hemorrhage

69
Q

Upper GI Bleed

Diagnosis

A 
Upper endoscopy after hemodynamic stabilization
Cardiopulmonary concerns d/t blood & gastric content aspiration risk
Prefer ETT (secured airway)
70
Q

Upper GI Bleed

S/S

A

Hypotension & tachycardia
Orthostatic hypotension
Melena indicated bleeding ABOVE the cecum
↑BUN

71
Q

Upper GI Bleed

Treatment

A

Endoscopic coagulation - perforation risk
Epi injection
Endoscopic ligation (bleeding varices)
Trans-jugular intrahepatic portosystemic shunt (TIPS) esophageal varices resistance to treatment → worsen encephalopathy
Mechanical balloon tamponade via Blakemore-Sengstaken tube
Refractory GI bleeding → oversew ulcer or perform gastrectomy

72
Q

Lower GI Bleed

A

Usually from diverticulosis or tumor

Common in older patients

73
Q

Lower GI Bleed

Diagnosis

A

Sigmoidoscopy to exclude anorectal lesions

Colonoscopy

74
Q

Lower GI Bleed

S/S

A

Bright red blood & clots via the rectum

75
Q

Lower GI Bleed

Treatment

A

Angiography embolic therapy

Surgical intervention required about 15%

76
Q

Lower GI Bleed

A

Usually from diverticulosis or tumor

Common in older patients

77
Q

Lower GI Bleed

Diagnosis

A

Sigmoidoscopy to exclude anorectal lesions

Colonoscopy

78
Q

Lower GI Bleed

S/S

A

Bright red blood & clots via the rectum

79
Q

Lower GI Bleed

Treatment

A

Angiography embolic therapy

Surgical intervention required about 15%

80
Q

Adynamic Ileus

A

Formerly known as acute colonic pseudo-obstruction
Massive dilation w/o mechanical obstruction
Loss effective colonic peristalsis & subsequent colon distention

81
Q

Adynamic Ileus

Causes

A 
Seriously ill hospitalized patients
- Electrolyte disorders
- Immobile
- Narcotic/ anticholinergic medications
- Surgical patients
Excessive SNS & lack PSNS input
82
Q

Adynamic Ileus

Diagnosis

A

CXR proximal colon dilation & decompressed distal colon w/ air in rectosigmoid region

83
Q

Adynamic Ileus

Treatment

A 
Correct electrolyte abnormalities
Avoid narcotics & anticholinergics
Mobilization
Tap water enemas
NG suction
Conservative treatment usually takes 2 days

Neostigmine IV (monitor bradycardia), repetitive colonoscopy, and/or cecostomy placement

Untreated → R colon & cecum ischemia

AS - N935 Advanced Patho II (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions