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Patho/Pharm 378 > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

Dysphagia

A 
Difficulty swallowing which creates a risk of airway compromise
Involuntary and voluntary
Mechanical obstruction: tumors
Neurological dysfunction
Spasmodic or Prolonged
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2
Q

Esophageal spasm treatment

A

Nitrates: relax smooth muscle
Ca+ channel blockers
Botox: paralyzes muscles
Peppermint: antispasmodic

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3
Q

Gastro-esophageal Reflux Disease (GERD)

A

Reflux of stomach content into esophageal
Sx: heartburn, dysphagia, globus, chronic cough, asthma, upper abdominal pain, chest pain
Nursing Implication: is the patient on a ACE medication? (coughing)

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4
Q

GERD Causes

A

Age, increased abdominal girth from obesity, eating large meals, tobacco and alcohol use, caffeine intake, anatomic hiatal hernia
Esophagus can be damaged from acidity causing: inflammation, scarring, stricture, metaplasia tissue

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5
Q

Hiatal Hernia

A

a portion of the stomach passes through esophageal sphincter, can cause GERD but not most common

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6
Q

Barrett Esophagus

A

Compensatory replacement of normal esophageal squamous epithelium

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7
Q

GERD Tx

A

Treat the cause

  • obesity: suggest diet and limit large meals and alcohol consumption
  • hiatal hernia: repair hernia
  • Medications: Antacids, H2 blockers, PPI
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8
Q

Anorexia

A

Lack of desire to eat
Can be from fatigue, anemia, cancer, heart dx, renal dx, depression
Treat the cause

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9
Q

Nausea

A

subjective sensation secondary to stimulation of the medullary control center
May be accompanied by ANS manifestation such as salivation, sweating, pallor, or inadequate supply of blood to gastric from pregnancy, viral infection, abdominal distention

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10
Q

Vomitting

A

physiologic protective mechanism, medullary center of control

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11
Q

Anorexia Nervosa

A

Psychiatric disorder of body image disturbance wit lengthy complex therapy

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12
Q

Metoclopramide

A

delayed gastric emptying treatment medication for anorexia

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13
Q

Cannabis derivative

A

appetite stimulant

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14
Q

Nausea and Vomiting non drug

interventions

A 
self hypnosis
biofeedback: breathing and relaxation
acupuncture/pressure points
Peppermint oil: indigestion
Ginger: mixed evidence for relief of nausea during pregnancy
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15
Q

Bismuth Subsalicylate

A 
Pepto
More for anti-diarrhea
ADR: black stool/tongue
readily available OTC
Not recommended for pregnancy bc of Aspirin
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16
Q

Tx for Nausea and Vomiting

A

Medication: benzodiazepines, pronabinol, isopropyl alcohol

receptors of serotonin, dopamine and substance P can be partially blocked

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17
Q

Anti-emetics: Dopamine Antagonists

A

Promethazine: can be used as a sedative before and after surgery, can help control pain, motion sickness,
Chlorpromazine
Both can be given: po, IM, IV, or recatally
Both can cause: sedation, hypotension, extra pyramidal reactions

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18
Q

EPS

A

Acute disorder of the motor neurons responsible for certain movements associated with a number of psych meds
Sx: dystonia, parkinson syndrome, rapid tongue movement

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19
Q

Droperidol

A

Anti-emetics: Dopamine Antagonists
same side effects as other dopamine antagonists (sedating, hypotension,EPS)
stronger sedating effect
Black box warning

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20
Q

Metoclopramide

A 
Anti-emetics: Dopamine Antagonists
unique in increasing tone and motility of the GI tract which promotes gastric emptying
Used pre/post operatively
Less often used in Chemo
Commonly used for N&V
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21
Q

Promethazine

A

Anti-emetics: Dopamine Antagonists

can be used as a sedative before and after surgery, can help control pain, motion sickness

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22
Q

Ondansetron

A

Anti-emetic: Serotonin Antagonist
Highly effective antiemetic
Used for N&V during chemo/radiation, and postoperatively
more effective when given in combination with a steroid
ADR: headache, lightheadedness, diarrhea, No EPS

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23
Q

Substance P Antagonist

A

Substance P is a neurotransmitter
NK-1 receptors in medullary vomitting center and vagus respond to substance P
Aprepitant: antagonizes substance P receptor
useful for chemotherapy induced nausea and vomiting

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24
Q

Diphenhydramine

A

Antihistamine
reduces inflammatory response, can cause sedation effects, given for n and v, typical anti-cholinergic effects
ADR: dry mouth, urinary retention, constipation, blurred vision

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25
Q

Hydroxizine

A

Antihistamine
Most commonly used for N&V
Have an anticholinergic effect, causing sedation
ADR: dry mouth, urinary retention, constipation, blurred vision

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26
Q

Meclizine

A

Antihistamine
Can treat motion sickness and vertigo, given for n and v
Have an anticholinergic effect, causing sedation
ADR: dry mouth, urinary retention, constipation, blurred vision

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27
Q

Scopalamine

A

Antihistamine
Can treat motion sickness and pre/postoperative n and v, can decrease salivation
Have an anticholinergic effect, causing sedation
ADR: dry mouth, urinary retention, constipation, blurred vision

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28
Q

Glucocorticosteroids

A

Primarily in use with against with chemo
MOA is unclear
Can be given for N and V and with Ondansetron

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29
Q

Benzodiazepines

A

Anxiolytic and sedating effect, used for sleeping and anxiety

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30
Q

Isopropyl Alcohol

A

Small study

Inhaled aromatherapy shown to decrease N&V with or without Ondansetron

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31
Q

Gastritis

A

inflammatory disorder of gastric mucosa

Heliobacter Pylori: major causative factor

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32
Q

Acute Gastritis

A

Erosion of surface epithelium in a diffuse of localized pattern
Injury by virus, drug of chemical
Tx: correct the problem and treat symptomatically

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33
Q

Chronic Gastritis

A

Thinning or degration of stomach wall

Tx: correct the problem and treat symptomatically

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34
Q

Gastric Ulcer/PUD

A

Sore inside stomach

Risk factors: advanced age, tobacco use, alcohol/smoking, chronic disease with circulation or O2 impairment

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35
Q

Sx of Gastric Ulcer/PUD

A

Epigastric pain: gnawing, burning, may radiate to chest, may have exacerbation and remissions
burping or belching
occult blood in stool
Severe cases: pain and peritonitis

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36
Q

Non drug Tx for Gastric Ulcer/PUD

A

Dietary modifications: no clear association with spicy foods or improvement with bland diet, no clear association with caffeine
Smaller more frequent meals to limit gastric acid fluctuation
smoking cessation
conflicting evidence about alcohol

37
Q

Pharmaceutical Tx for Gastritis/PUD Antacids

A

Antacids
Acid blockade by alkaline compounds to neutralize stomach acid
NaHCO3: binds with acid but liberates Co2 and contains sodium
Aluminum Hydroxide: slower actin/constipation
Magnesium Hydroxide: faster acting/diarrhea
Combination agents: Mylanta, Maalox
All antacids may reduce dissolution and absorption of other drugs

38
Q

H2 Blockers

A

Located in the parietal cells of the stomach and promote secretion of gastric acid
H2 Blockers antagonize the reception by decreasing the secretion of gastric acid

39
Q

Pharmaceutical Tx of Gastritis/PUD H2 blockers

A

Ranitidine
Famotidine
Cimetidine
Drug-Drug interactions: antacids, warfarin, phenytoin

40
Q

Proton Pump Inhibitor

A 
More powerful then H2 blockers
1 dose decreases gastric acid by 97%
not rapidly onset
complex MOA
All drugs listed decrease gastric acid:
omeprazole
pantozole
iansoprazole
rebeprazole
esomeprazole
41
Q

PPI ADR

A

Rare for short term use

Drug drug interactions are rare

42
Q

Sucralfate

A

Activated by acid pH to form a gel which physically coats the ulceration
No known ADRs

43
Q

Misoprostol

A

An endogenous prostaglandin useful for clients on NSAIDs
Obstetric use for ripening of Cervix
Contraindicated: pregnant patient
Common ADR: diarrhea

44
Q

Helicobacter Pylori

A

A bug-a gram negative rod which can survive the acid rich environment of the stomach and colonizes the mucus secreting epithelium
produces Enzymes and toxins which impair mucosal protective barrier
associated with gastritis, peptic ulcers, and various gastric cancers
Tx: multi drug regiment

45
Q

Tx of Helicobacter Pylori

A

Multi drug regimen
2 antibiotics secondary to rapid mutations of H Pylori
PPI to alter acidic environment
Requires 3-4 drugs to treat
Bismuth can be added bc of antibacterial effects against H Pylori

46
Q

Bowel Function

A

Large bowel: absorption of water
90% of water is reabsorded
rapid passage through bowel can cause liquid stools
delay in bowel contents can cause excess water reabsorption and subsequent hard dry stools
Dietary fiber increases stool bulk and keeps water within bowel

47
Q

Constipation

A

Varying definitions and individualized
individual norms and subject to change based on age, activity level, food intake, fluid balance, activity
May be secondary to another cause
-hypothyroidism
-neuromuscular disorders
Common SFX: narcotics, ca+ channel blockers, iron supplements
May be voluntarily influenced by pain and social factors of embarassment

48
Q

Constipation Tx

A 
Manage underlying problems
Exercise, fluids, fiber
providing adequate provers
Bulk Supplements: Psyllium
-safe for daily use
Stool softeners/laxatives
Enemas
49
Q

Stool Softeners

A

Inhibit fluid reasborption from the stool

stimulate excretion of water and elites into the lumen of the bowel (ex: decussate sodium)

50
Q

Laxatives-stimulants

A

Stimulate intestinal motilivty

stimulates excretion of water and elites into the lumen of the bowel (ex: bisacodyl, Senna)

51
Q

Laxatives-osmotic

A

Salt based laxative pulls fluid into the lumen of the bowel so the bowel wall is stretch and increases peristalsis
powerful laxatives can cause fluid loss and dehydration
ex: magnesium hydroxide

52
Q

Indications for Laxative use

A 
Diagnosis
Tx/Procedure preparation
Constipation 
-pregnancy
-opioids
-post op
-preventative valsalva in pts with aneurysms, varices
poisoning
53
Q

Contraindications to Laxative use

A

Abdominal pain, nausea, cramping with possibility of obstruction, appendicitis, surgical abdomen

54
Q

long term use of laxatives

A

laxative use will diminish the normal function of the bowel and can create dependency
can also cause dehydration and e-lyte balance

55
Q

Intestinal obstruction

A

caused by a condition that prevents the flow of gut connects through the intestinal lumen
EX: hernia, adhesions

56
Q

paralytic ileus

A

failure of motility, usually after surgery and use of narcotics

57
Q

Tx of Intestinal obstruction

A

NG suction
mobilization
immediate surgical interventions

58
Q

Tx of paralytic ileus

A

intestinal motility agents (ex: metoclopramide)

antisecretory

59
Q

Diarrhea

A

Definition vary by individual
increased frequency of stool
watery consistency
Symptom not a disease

60
Q

Diarrhea causes

A 
infection
foods
drugs
bowel pathology
may be protective
61
Q

Diarrhea-large volume secretory

A

associated with infection or food that are non agreeable

Tx: fasting

62
Q

Diarrhea-small volume inflammatory

A

associated with intrinsic bowel disease
straining with little stool
bloody stool and some pain

63
Q

Tx of Diarrhea

A

removal of offending agents
restoration of fluids and elytes
manage of distressing sx
probiotics: lactobacillus: supports normal intestinal bacteria

64
Q

Viral diarrhea

A

self limiting and antibiotics can worsen sx

65
Q

Bacterial diarrhea

A

ecoli
salmonella
some tx require abx

66
Q

ex of a antidiarrheal agent

A

bismuth subsalicylate

67
Q

why are opioids use in tx for diarrhea

A

opioids help firm up stool and is typically paired with atropine to slow bowel function

68
Q

bulk forming agents for diarrhea

A

reduce watery consistency of stool

69
Q

Irritable Bowel Syndrome

A

described as a syndrome of a symptom, increasingly well recognized but still questioned
constellation of sx without objective pathology
associated with abdominal pain and often relieved with defacation

70
Q

Inflammatory Bowel

A

represents recognized objective pathology

some genetic predisposition and general recognition of an autoimmune component

71
Q

Crohns Disease

A

inflammatory bowel
Autoimmune disease with some genetic predisposition
colicky abdominal disease with diarrhea and dehydration
lesions can be seen on the bowel wall
exacerbations and remissions but progress with thickening of the bowel wall, malabsorption, fistula formation, GI complications

72
Q

Non GI complications from Crohns Disease

A

arthritis
Skin lesions
other inflammatory problems

73
Q

Ulcerative Colitis

A

inflammatory condition of the bowel

Sx are similar to crowns but with worsened diarrhea and frequent bloody stool

74
Q

Ulcerative Colitis risk factors

A

risk of colon cancer is 20-30x more likely then the general population

75
Q

Tx of Ulcerative Colitis without medications

A

Maximiza nutrition

minimize inflammation

76
Q

Tx of Ulcerative Colitis with medications

A

Glucocorticoids: sx relief and often used for remission, chronic use can cause adrenal suppression and cushing syndrome
Sulfasalazine: chemically related to sulfa, abx, used for anti-inflammatory
Immunosuppresants: Azathioprine, cyclosporine, methotrexate

77
Q

Bacterial infection of the bowel

A

organisms that proliferate in the bowel and can cause destruction, may has massive diarrhea, fluid loss, dehydration
common organisms: ecoli, salmonella, cdifficile

78
Q

Diverticuli

A

herniation of musical layer of the colon through mucosal layers creating pouches
common in refined diet population

79
Q

Diverticulosis

A

presence of lesions, typically asymptomatic,

tx: with high fiber diet

80
Q

Diverticulitis

A

inflammation, infection, can cause perforated of diverticuli which can cause a peritonitis abscess formation
can cause severe pain, N/V, elevated WBC

81
Q

Tx for Diverticulitis

A

antibiotic

NPO

82
Q

Appendicitis

A

inflammation with progressive infection and eventual perforation
onset: 1-2 days gradually localized to RLQ

83
Q

S/S. of Appendicitis

A

anorexia
low grade fever
mild elevation of WBC

84
Q

Dx of Appendicitis

A

CT scan

US

85
Q

Tx of Appendicitis

A

surgical removal of appendix usually laparoscopic

if perforated: will need appendectomy and abx

86
Q

Colorectal Cancer

A

2nd leading cause of cancer related deaths
pathology: genetic predisposition, 90 mutant genetic patterns identified
transition of normal epithelium to adenoma to carcinoma as a result of progressive chromosomal instabilty

87
Q

Risk factors of Colorectal Cancer

A 
family Hx
diet high in fat and meat
obesity/belly fat
smoking
sedentary lifestyle
screening
88
Q

screening for Colorectal Cancer

A

guiac fecal occult blood test
fecal immunochemical test: measures HgB protein antibodies
Cologaurd: most sensitive test

Patho/Pharm 378 (2 decks)

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