Gastrointestinal Disorders (pptx 2, part 2) Flashcards by noelle wilson

List 2 types of inflammatory bowel disease

1) Crohn’s disease
2) Ulcerative colitis

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What is Crohn’s disease?

A recurrent, granulomatous type of inflammatory response affecting the GI tract
Periods of exacerbations / remissions

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What is the most common site for Crohn’s disease to develop?

Terminal ileum or cecum

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Describe appearance of Crohn’s disease

Cobblestone appearance

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List 6 Sx of Crohn’s disease

1) Diarrhea
2) Abdominal pain
3) Weight loss
4) Fluid & electrolyte imbalance
5) Malaise
6) Low grade fever

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List 3 complications of Crohn’s disease

1) Fistula formation
2) Abdominal abscess
3) Intestinal obstruction

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What is ulcerative colitis? Hint: 3

1) Non-specific inflammatory condition of the colon
2) Often begins gradually & can become worse over time
3) Cause is unknown

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When does ulcerative colitis commonly occur? Hint: 4

1) Btwn ages of 15 & 30
2) Older than 60 yrs
3) Have a family member w IBD
4) Is of Ashkenazi Jewish descent

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List 9 Sx of Ulcerative colitis

1) Diarrhea w blood/ pus
2) Abdominal discomfort
3) Urgent need to have BM
4) Fatigue
5) Nausea
6) Loss of appetite
7) Weight loss
8) Fever
9) Anemia

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Tx of ulcerative colitis depends on _____

Severity

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What do ulcerative colitis increase the risk of?

Colon cancer

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Crohn’s vs. Ulcerative Colitis:

Types of inflammation

Crohns: Granulomatous
UC: Ulcerative & exudative

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Crohn’s vs. Ulcerative Colitis:

Level of involvement

Crohn’s: Primarily submucosal
UC: Primarily mucosal

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Crohn’s vs. Ulcerative Colitis

Extent of involvement

Crohn’s: Skip lesions
UC: Continuous

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Crohn’s vs. Ulcerative Colitis:

Areas of involvement

Crohn’s: Primarily ileum, secondarily colon
UC: Primarily rectum & left colon

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Crohn’s vs. Ulcerative Colitis:

Diarrhea

Crohn’s: Common
UC: common

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Crohn’s vs. Ulcerative Colitis:

Rectal bleeding

Crohn’s: Rare
UC: common

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Crohn’s vs. Ulcerative Colitis:

Rectal bleeding

Crohn’s: Common
UC: Rare

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Crohn’s vs. Ulcerative Colitis:

Fistulas

Crohn’s: Common
UC: Rare

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Crohn’s vs. Ulcerative Colitis:

Strictures

Crohn’s: common
UC: Rare

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Crohn’s vs. Ulcerative Colitis:

Perianal abscesses

Crohn’s: common
UC: Rare

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Crohn’s vs. Ulcerative Colitis:

Development of cancer

Crohn’s: Uncommon
UC: Relatively common

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What is diverticular disease?

A condition of having diverticula (an outpouching) in the colon

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Where does diverticular disease commonly occur?

Descending or sigmoid colon

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Approx what % of the US population is affected by diverticular disease?

~ 40% by age 60

What is diverticulitits?

Inflammation of the diverticulum

List 4 Sx of diverticulitis

1) Pain 2) N/V 3) Fever 4) Elevated WBCs

List 5 complications of diverticular disease

1) Perforation w peritonitis 2) Abscesses 3) Hemorrhage 4) Fistula 5) Bowel obstruction

List 3 drug classes that decrease acid production

1) H2 blockers 2) PPI 3) Prostaglandin analogs

List 4 Medications considered H2 blockers that decrease acid production

1) Cimetidine 2) Ranitidine 3) Famotidine 4) Nizatidine

List 3 PPIs that decrease acid production

1) Omeprazole 2) Lansoprazole 3) Pantoprazole

List an example of prostaglandin analogs that decrease acid production

Misoprostol

List a drug class that neutralize activity of acid & pepsin

Antacids

Give an example of a medication that neutralizes activity of pepsin

Sucralfate

List 2 medications that enhance mucosal protection & 2 things to avoid

Meds: 1) Misoprostol 2) Sucralfate Avoid: 1) NSAIDs 2) Alcohol

What 2 drug classes eradicates H. pylori & list 4 examples

Drug class: Abx; PPIs Ex: Amoxicillin; Clarithromycin; Metronidazole; Tetracycline

List 2 drug classes that increase esophageal sphincter tone

1) Antacids 2) Metoclopramide

How do H2 blockers work? **Hint: 3**

1) Block H2 receptors on parietal cells leading to decrease gastric acid secretion 2) Decrease HCL production by ~ 70% 3) Cross placenta & breast milk

List 2 indications for giving H2 blockers

1) GERD 2) PUD

Suffix for H2 blockers

"tidine"

List 5 side effects of H2 blockers

1) Diarrhea 2) Constipation 3) Drowsiness 4) H/A 5) Hypotension

What decreases effectiveness of H2 blockers?

Smoking

List 3 drugs considered H2 blockers

1) Ranitidine (Zantac) 2) Famotidine (Pepcid) 3) Cimetidine (Tagamet)

4 Patient teaching points for H2 blockers

1) Take 30 min before meals 2) Avoid overeating 3) No smoking 4) NO NSAIDs

How do PPIs work?

Suppress gastric acid production

List 4 indications for giving PPIs

1) PUD 2) H. pylori 3) GERD 4) Dyspepsia

List 5 side effects of PPIs

1) nausea 2) Diarrhea 3) Abdominal pain 4) Fatigue 5) H/A

List 6 things PPIs increase the risk of

1) fractures 2) Dementia 3) Infection 4) Gastric cancer 5) CV events 6) Kidney disease

List 4 labs to monitor for a pt taking PPIs

1) B12 2) Calcium 3) Magnesium 4) Iron

What drug do PPIs interact with?

Clopidogrel

Suffix for PPIs

"prazole"

List 5 medications considered PPIs

1) Omeprazole (Prilosec) 2) Lansoprazole (Prevacid) 3) Rabeprazole (Aciphex) 4) Pantoprazole (Protonix) 5) Esomeprazole (Nexium)

How do antacids work? **Hint: 2**

1) Neutralize stomach acid by direct contact 2) May stimulate prostaglandins

List 3 indications for giving antacids

1) Gastritis 2) GERD 3) PUD

List 4 types of antacids

1) Sodium bicarb 2) Calcium carbonate 3) Aluminum hydroxide 4) Magnesium hydroxide

List 3 side effects of antacids

1) Depend on type 2) Constipation/ diarrhea 3) Sodium loading

What GI medication has multiple drug interactions?

Antacids

List 2 adverse effects of aluminum compound antacid

1) Constipation 2) Hypophosphatemia

List 3 adverse effects of magnesium compound antacids

1) Diarrhea 2) Hypermagnesemia 3) Impaired renal function

Patient education for taking magnesium compound antacids **Hint: 2**

1) Do NOT use if impaired kidney function 2) Monitor for CNS depression

List 2 adverse effects of calcium compound antacids

1) Constipation 2) Hypercalcemia

List 2 adverse effects of sodium compound antacids

1) Fluid retention 2) Alkalosis

Patient education for sodium compound antacids

Avoid if Hx of HTN or HF

List 3 patient teaching more for antacids as a whole

1) Take ALL meds at least 1 hr before or after taking antacid 2) Chew tabs & drink at least 8 oz of fluid after 3) Shake liquid before pouring dose

List 2 mucosal protectants

1) Sucralfate 2) Misoprostol (Cytotec)

Sucralfate **Hint: 3**

1) Polymer of sucrose w aluminum hydroxide 2) Forms protective coating on mucosal lining, particularly in ulcerated areas 3) Adheres to epithelial cells, ulcer craters, or eroded areas

Administration of sucralfate

Give QID on empty stomach, one hr before meals & at bedtime

List 1 adverse effect of sucralfate & when to use with caution

1) Constipation 2) Caution in those w renal impairment

List 4 medications that cause drug interactions with sucralfate

1) Antacids 2) Warfarin 3) Phenytoin 4) Fluoroquinolones

Misoprostol (Cytotec) **HInt: 2**

1) Prostaglandin analog 2) Decreases gastric acid secretion, & increases GI BF, & stimulates mucus production

List an indication of giving misoprostol

1) PUD **Not effective for GERD**

Administration of misoprostol

Admin 2-4 times a day

List 3 side effects of misoprostol

1) Diarrhea 2) Abdominal pain 3) H/A

List 3 contraindications of Misoprostol

1) Pregnancy 2) Lactation 3) Irritable bowel disease