Gastrointestinal (TCM Review handout Full) Flashcards
Review the TCMreview.com notes on GI
Obesity
Underweight – Below 18% • Healthy – 18.5 – 24% • Overweight – 25 - 30% • Obese – 31% and up
Salivary Amylase
Digests Starches
Lipase
Digests Lipids
Protease
Digests Protein
Ribonuclease
Digests Nucleic Acids
Lactase
Digests Milk Sugars
Glucoamylase
Digests Malt Sugars
Nucleotides & Phosphatases
Digests Nucleotides
Bile
Digestion of lipids pH of 7.5-8.8
Pepsin
Digests Protein
Pancreatic Amylase
Maltose, maltotriose, alpha dextrins
Trypsin
Peptides
Lysozyme
Kills bacteria
Saliva
pH of 6.5-7.5 moistens and lubricates
Antihelmintic
Mebendazole (vermox), pyrantel pamoate (combantrin, antiminth)
Antibiotics
Amoxicillin (amoxil), azithromycin (zythromax), cefproxil (cefzil), ciprofloxacin (cipro), clarithromycin (biaxin XL), levofloxacin (Levaquin)
Anti-diabetic
Metformin (Glucaphage), glipizide (Glucotrol), Glyburide (Micronase), Pioglitazone HCL (Actos)
Antidiarrheal
Bismuth subsalicylate (Pepto-Bismol), Kaolin and pectin mixtures (Kaopectate), loperamide HCl (Imodium)
Antiemetic
Prochlorperazine (Compazine), promethazine (Phenergan), trimethobenzamide HCl (Tigan)
Antifungal
Amphotericin B (Fungizone), Fluconazole (Diflucan), Nystatin (Mycostatin), Terbinafine (Lamisil)
Carthartic (Laxative)
Bisacodyl (Duclolax), casanthranol (Peri-Colace), magnesium hydroxide (Milk of Magnesia)
Absorption
Stomach: Alcohol, water, some fat soluble drugs.
Small Intestine: Nutrients Mainly
Large Intestine: Re-absorption of water, electrolytes
Fat-soluble vits ADEK: absorbed with fats in SI
Type 1 Diabetes
S/S: Ketoacidosis, polydipsia, polyuria, polyphagia, fatigue, parasthesia
Complications: Retinopathy, hypertension, neuropathy, ulcerations, infections and fractures
Infections: Foot, mouth, vagina (due to bacterium)
Treatment: Insulin
Lab tests: HbA1C
Type 2 Diabetes
S/S: Dry flushed skin, ketonic breath, nausea and vomiting, LOC, seizure, cramping, polyuria, dizziness, blurred vision, confusion
Complications: Retinopathy, loss of vision, nephropathy causing hypertension, neuropathy, ulceration of feet, infections and fractures
Infections: Foot, mouth, vagina (due to bacterium)
Treatment: Insulin replacement, basal and post prandial
Lab tests: HbA1C
Hypoglycemia ( blood glucose less than 70/ 3.9)
S/S: Sweating, nausea, warmth, anxiety, tremulousness, palpitations, hunger, headache, blurred or double vision, confusion, seizures, decrease in body temperature
Treatment: Glucagon
Lab Tests: Fasting glucose, serum insulin, C-peptide
Blood Sugar Levels
Before meals: less than 100 mg/dl (5.5 mmol/l) non diabetics and 80–130 mg/dl (4.4-7.2 mmol/l) for diabetics
1–2 hours after the start of a meal: less than 140 mg/dl (7.8 mmol/l) for non diabetics and less than 180 mg/dl (10 mmol/l) for diabetics
GERD
Lower esophageal sphincter reflux, burning pain and stricture
Emesis
Over expansion of the digestive system due to bacteria, virus or micro trauma of the esophagus from stomach acids
Gastritis
Pain, nausea, fullness, bleeding, due to NSAIDs or ethanol, or smoking; proton pump inhibitors can be a cause as well as a temporary cure
Peptic ulcer
Common in Hispanic and African Americans due to H. Pylori weakening the stomach lining. Can either be gastric or duodenal.
Gastric ulcer
Occurs in the stomach leading to bleeding ulcers: refer to physician ASAP
Duodenal ulcer
Mostly caused by H.Pylori or NSAIDs, smoking prevents healing; more consistent pain which usually awakens patient at night
Thrush
Candida Albicans (fungus) possibly from immune compromised persons or people on aggressive antibiotic therapy or steroid (asthma) use: treat with anti-fungals
Halitosis
Bad breath coming from the stomach
Gastric Cancer
Indigestion, anorexia, abdominal pain and weight loss; often metastasizes to the lymph, liver, peritoneum, chest and brain: refer to physician STAT
Melena
Black tarry stool due to long-term stomach or duodenum bleeding
Adenovirus
4th most common childhood gastroenteritis disease: DNA virus
Salmonella
Bacterial diarrhea due to under cooked poultry, milk, eggs or contact with reptiles (fecal oral route)
Shigella
Third most common bacterial diarrhea in U.S. transmitted person to person
Escherichia coli
Blood in diarrhea from undercooked beef, unpasteurized milk, juice and canning; may also have watery diarrhea; found commonly in nurseries: bacteria
Vibrio
Diarrhea caused by undercooked seafood: bacteria
Listeria
Food born and usually found in cheese: bacteria
Constipation
Red Flag if patient is on opioids
Dyspepsia
Upper abdominal distention with postprandial fullness that is gnawing or burning; epigastric pain with nausea and vomiting Tx: H2 blockers, Proton pump inhibitors
HBA : 甲型肝炎 incubation etc.
Nucleic Acid: RNA Serologic test: IgM Anti-HA Major transmission: Fecal-oral CNT Incubation: 15-50 with AVG: 28 Incubation period days: 15-45 Liver Cancer: No
HBV: B型肝炎 incubation etc.
Nucleic Acid: DNA Serologic test: HBsAG Major transmission: Blood CNT Incubation: 45-160 Incubation period days: 40-180 Liver Cancer: Yes
HCV: 丙型肝炎 incubation etc.
Nucleic Acid: RNA Serologic test: Anti-HCV Major transmission: Blood CNT Incubation: 14-180 Avg. 5-10 weeks Incubation period days: 20-120 Liver Cancer: Yes
HVD: 丁型肝炎 incubation etc.
Nucleic Acid: Unknown Serologic test: Anti-HCD Major transmission: Needle CNT Incubation: unknown Incubation period days: 30-180 Liver Cancer: Yes
HVE: 戊型肝炎 incubation etc.
Nucleic Acid: RNA Serologic test: Anti-HCE Major transmission: WATER CNT Incubation: 15-60 Incubation period days: 14-60 avg 40 Liver Cancer: No
Most common type of hepatitis in medical field
Hepatitis B
Most common hepatitis found in the world:
Hepatitis A
Deadliest type of Hepatitis
Hepatitis C
HAV S/S
Fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, dark urine, clay colored bowel movement, joint pain, jaundice
HBV S/S
Fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, dark urine, clay colored bowl movement, joint pain, jaundice
HCV S/S
Fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, dark urine, clay colored bowel movement, joint pain, jaundice
Cholecystitis
Occurs as a complication to Cholelithiasis. Can be Uncomplicated with no S/S. Can also be complicated
S/S: Localized pain RUQ with rebound and guarding tenderness; positive Murphy sign, frequent fever, absence of peritoneal signs, tachycardia, diaphoresis, may have hypoactive bowel signs.
Misdiagnosed with: Pancreatitis;
CBC, Liver function panel, amylase, lipase
Cholelithiasis
Symptoms occur when there is stones present.
S/S: Sporadic, unpredictable usually with pain in the epigastrium or RUQ, sometimes radiating to the right scapular tip. Pain is post prandial with an intense or dull pain lasting 1-5 hours which progresses for 10-20 minutes then goes away. Pain is constant, not relieved with emesis, defecation, flatus, positional changes or antacids. Additional symptoms: Indigestion, dyspepsia, belching, bloating. CBC, Liver function panel, amylase, lipase
Crohn’s Disease Facts
Small intestine is involved in 80% of cases (esophagus to anus can also be affected)
Colon involvement is usually right sided, usually feels like appendicitis
75-85% of cases can have rectal bleeding; fistula and abscesses are common; 25-35% of cases have perianal lesions. TRANSMURAL
Asymmetrical and segmental (skip areas) on X-ray Endoscopy appearance is patchy with normal mucosa
Ulcerative Colitis Facts
Disease is in the colon only; Superficial lesions, primarily in the descending section. Involvement is usually left sided. Rectal bleeding is always present; fistulas do not occur; no perianal lesions.
Symmetrical and uninterrupted bowel wall Inflammation is uniform and diffuse
Appendicitis Facts
LRQ pain that can lead to peritonitis.
McBurney’s point: pressing on LRQ with rebound tenderness
Rovsing’s sign: press on LLQ causing more pain on LRQ
Appendectomy
Diverticulosis Facts
Small pouches bulging outward through weak spots in large intestine; asymptomatic until inflamed; patient usually has low fiber diet; caused by heavy pressing due to constipation. Barium enema or colonoscopy. High fiber diet, angiographic or endoscopic treatment of bleeding: avoid seeds and antispasmotics.
Diverticulitis Facts
Inflamed Diverticuli due to low fiber diet. Abdominal CT, colonoscopy. Liquid diet, oral antibiotics; severe cases require IV antibiotics or surgery
Ulcerative colitis Facts
Extensive inflammation and ulceration (superficial) of large intestine, bloody diarrhea (a bit more acute) , cramping pain.
Dx:
Tx:
Irritable Bowel Syndrome (IBS) Facts
Usually due to stress however etiology unknown; gas, bloating, cramping, bowel changes, constipation or diarrhea (See Crohn’s and UC) add: eye discomfort, extreme fatigue, joint pain, rectal bleeding. Counseling, normal diet, avoid gas-producing foods, diarrhea producing foods, increase fiber for constipation, loperamide for diarrhea, tricyclic antidepressants
Rotavirus
Viral: most common cause of diarrhea in children and day care workers in America; can lead to dehydration due to watery diarrhea for 3-8 days
Toys, bathroom fixtures, changing tables, diaper pails, public swimming pools
Thoroughly wash hands and surfaces after changing diapers, refrain from going to pools when child has had diarrhea within the last 14 days
Giardia
Parasite: very common; found in day care centers, international travelers, hikers, unfiltered or untreated water; spreads community wide
Uncooked food that has been contaminated, swallowing water from pools, water exposed to wildlife, day care facilities, toys
Wash foods properly, avoid consuming unfiltered water, (boil water if needed), refrain from using swimming pools for 14 days following a child who’s been diagnosed with giardia
Cryptosporidium
Parasite: water borne and resistant to chlorine
Treatment Appendectomy
Pool water; can be found in day care settings
Avoid contaminated fruit or vegetables, drinking water from lakes or ponds, swimming in pools where children have had diarrhea within 14 days; this parasite can live in highly chlorinated water for several days
Meckel’s Diverticulum
All ages will have intestinal obstruction manifested by cramping, abdominal pain, nausea and vomiting. Acute cases will have abdominal pain either below or to the left of the umbilicus often accompanied by vomiting and are similar to appendicitis. FTests: H/H, Stool Smear, CT Scan, Trechnetium scan. Complications: Excess bleeding, intessuception, peritonitis, perforation refer To PCP
Roundworm
Intestinal blockage, bloating, large round worms in bowel movements, vomiting or crawling from nose. Unwashed raw foods, soil with eggs or water contaminated from pig feces; migrates through blood, lungs and then intestines. Small intestine is mostly affected Tx: antihelminics
Hookworm (common in U.S.)
Loss of appetite, loss of weight, abdominal distention, anemia, intestinal bleeding. Contaminated soil, water contamination, unwashed raw foods. Infests biliary tract, pancreas Tx: corticosteroids and antihelminics
Pinworm
Very common in schools and daycare centers and passed on to people in one household: itchy perineum is the most common symptom. Very common in day care centers, anus to mouth transmission and then spreads from clothing, bedding, furniture. Affects lower intestine Tx: antihelminics
Tapeworm
Abdominal distention, pain, diarrhea, malnutrition, Weight Loss. Can develop large cysts in the liver and lungs, usually found in contaminated soil or fish, poor sanitation; may have no symptoms for months to years. Can develop large cysts in the liver and lungs, usually found in contaminated soil or fish, poor sanitation; may have no symptoms for months to years
Trichinosis
Stomach pain, extreme fatigue, nausea and vomiting, diarrhea, fever, headache, chills, swelling of the eyes, cough, muscle aches, may have constipation, heart palpitations, dyspnea. Mimics Syphillis. Large intestine is primarily affected; also affects muscles, brain and other organs Tx: antihelminics
Manual Tests
McBurney’s Point: Appendicitis, look for rebound tenderness.
Murphy’s Sign: Cholelithiasis, cholecystitis
Obturator Muscle Test: Rule out appendicitis
Psoas Sign: Rule out appendicitis
Rovsing’s Sign: Rule out appendicitis
